Starting salvage radiotherapy early

This study evaluated the results of early salvage radiation therapy (ESRT) in prostate cancer patients after radical prostatectomy.

Following radical prostatectomy (surgical removal of the prostate gland), prostate cancer often recurs and requires further treatment. Surveillance for cancer recurrence is usually performed by measuring the blood levels of a protein called prostate-specific antigen (PSA). Raising PSA levels indicate increased growth of prostate cells, but not necessarily a new tumor. High PSA levels following treatment is referred to as biochemical recurrence since they raise the suspicion of cancer recurrence. However, not all cases of biochemical recurrence indicate an immediate threat to patients, and management of the early stages of biochemical recurrence is still a matter of some debate.

Many physicians recommend the use of radiation therapy (RT) following radical prostatectomy, and especially in cases of biochemical recurrence. However, since RT carries several serious side effects and risks, the optimal timing to begin treatment is still uncertain. Early salvage radiation therapy (ESRT) refers to RT given to patients at the very early stages of biochemical recurrence (when PSA levels are no higher than 0.5 ng/mL).

This review analyzed the results of 10 different trials investigating early salvage radiation therapy (ESRT) and including a total of 1212 patients.

Results showed that patients treated with ESRT experienced prolonged biochemical recurrence-free survival (BRFS; the period of time between treatment and until biochemical recurrence occurs) compared with those receiving delayed RT (initiated later on when PSA values are higher than 0.5 ng/mL).

An analysis from seven of the reviewed trials showed that 5 years after ESRT, 71% of patients were free of biochemical recurrence. In a similar analysis, ESRT combined with androgen deprivation therapy (ADT; hormonal treatments commonly used to prevent testosterone induced stimulation of prostate cancer) showed significantly higher survival rates compared to RT alone. 96% of patients receiving ESRT and ADT survived 5 years following treatment, and 82–86% of patients survived 10 years following treatment.

This review concluded that salvage radiotherapy after radical prostatectomy should be started during the early phases of biochemical recurrence.

Although demonstrating beneficial results, this review analyzed mostly retrospective studies rather than controlled trials directly comparing the effects of early versus late radiotherapy.

Consult with your physician regarding the surveillance for biochemical recurrence following surgery and the prevention of cancer recurrence.