Session Item

To determinate the factors related to outcome in patients presenting biochemical relapse after radical prostatectomy treated with salvage radiotherapy.

From 2002 to 2014, 168 patients were treated at our institution with salvage radiotherapy after radical prostatectomy for biochemical relapse. Overall survival (OS) and biochemical-relapse free survival (BRFS) were calculated using Kaplan-Meier and Cox-regression was used to assess possible prognostic factors. 

Mean age was 63 years (range 41-74). Gleason Score (GS) at diagnosis was ≤6 in 49.1% of patients, GS 7 in 42.2% and 6.2% GS ≥ 8. All patients underwent radical prostatectomy with pelvic lymphadenectomy in 50% of cases. Neoadjuvant androgen deprivation therapy (NADT) before surgery was given to 49.5%. The distribution of patients by pT stage was pT2a/b(40.8%), pT2c (36.5%), pT3(16.2%) and pT4(0.6%). Gleason Score was ≤6 in 30.7% of patients, Gleason 7 (57.4%) and Gleason ≥ 8 in 12% of patients. Positive surgical margins were reported in 40.5% of cases. Mean time to radiotherapy (RT) was 34 months (4-146) and mean PSA beforse salvage was 0.88ng/ml. Median follow-up was 118 months (range 6-233). 5 and 10-year OS were 93.1% and 80.2% and BRFS 89.5% and 75.5%, respectively.  Local recurrence was seen in 3 patients (1.8%), nodal recurrence in 8.9% and distant metastasis in 12.5%. Gleason Score, T stage and PSA levels at diagnosis and before salvage RT were significant predictors of BRFS. Positive surgical margins and absence of NADT were not related with worse BRFS. 

Salvage radiotherapy for biochemical relapse after prostatectomy provides good survival and biochemical control, comparable to those reported in the literature. Patients with higher PSA levels before RT have increased risk of biochemical recurrence so early salvage radiotherapy should be recommended.