radical prostatectomy (RP), salvage radiation therapy (SRT) is a second chance of cure. .... International Journal of Radiation Oncology * Biology * Physics.
S132
International Journal of Radiation Oncology Biology Physics
301
Results: We identified 541 patients who received salvage RT, of whom 194 received ESRT and had pT3 and/or positive margins. One hundred eightyseven patients received ART for adverse pathologic features. Median follow-up from surgery was 7.0 and 8.9 years in the adjuvant and salvage cohorts, respectively. Median time from surgery to ART was 4.5 months; median time to first detectable PSA after prostatectomy in the salvage cohort was 23.7 months. Of ESRT patients, 3.4% received preoperative ADT, and 9.7% received concurrent ADT. After RT, median time to biochemical recurrence was 4.4 and 5.0 years in the ART and ESRT cohorts, respectively. On MVA, compared to ESRT, ART was associated with improved 10-year FFBF (73.9 vs 59.5%, HR Z 0.36, 95% CI: 0.23e0.58, P < .0001) and 10-year FFADT (91.2 vs 83.2%, HR Z 0.37, 95% CI: 0.18e0.76, P Z .007). There were no significant differences in FFDM (95.8 vs 91.8%, HR Z 0.58, 95% CI: 0.19e1.7, P Z .3), and OS (97.8 vs 95.2%, HR Z 1.24, 95% CI: 0.4e3.89, P Z .7). Matching reduced the median bias caused by differences in baseline characteristics of ESRT (n Z 176) and ART (n Z 169) patients from 24.4% to 3.5% for unmatched and matched groups, respectively. After PS matching, adjuvant RT remained significantly associated with improved FFBF (P < .0001) and FFADT (P Z .01). Conclusion: Postprostatectomy RT confers excellent long-term prostate cancer control, a finding validated by the long follow-up in this series. ART is associated with reduced risk of PSA recurrence and need for subsequent ADT compared to ESRT, although there were no statistically significant differences in freedom from distant metastases and OS. Optimal timing of postoperative RT further awaits the results of ongoing randomized trials. Author Disclosure: D. Buscariollo: None. R.H. Clayman: None. S. Galland: None. A.S. Feldman: None. D.M. Dahl: None. F.J. McGovern: None. A. Olumi: None. A. Eidelman: None. A. Niemierko: None. W.U. Shipley: Stock; Pfizer. A.L. Zietman: Editor; International Journal of Radiation Oncology * Biology * Physics. J.A. Efstathiou: Member; NRG Oncology GU Core Committee, Board of Directors Massachusetts Prostate Cancer Coalition. Co-Chair; NCI Bladder Task Force, NRG Comparative Effectiveness Committee. Chair; ASTRO Genitourinary Cancer Submission Tracks.
PSA After Salvage Radiation Therapy for Postprostatectomy Biochemical Recurrence Predicts Long-term Outcome Including Overall Survival T. Wiegel,1 D. Bartkowiak,1 R. Bottke,1 W. Hinkelbein,2 and A. Siegmann2; 1University Hospital Ulm, Ulm, Germany, 2Charite´ University Hospital Berlin, Berlin, Germany Purpose/Objective(s): For patients with recurrent prostate cancer after radical prostatectomy (RP), salvage radiation therapy (SRT) is a second chance of cure. However, depending on pre-SRT risk factors, 40% to 70% of the patients experience further progression. Furthermore, the post-SRT level of prostate-specific antigen (PSA) is a prognostic marker. We report on the outcome of a cohort of patients who received SRT at 2 German centers. Materials/Methods: Between 1997 and 2011, 464 patients at 2 German centers, Berlin and Ulm, received SRT with 59.4 to 72 Gy (median, 66.6 Gy). All patient had 3-dimensional conformal treatment, including 60 cases with intensity modulated RT/volumetric modulated arc therapy technique. The median pre-SRT PSA was 0.31 ng/mL (interquartile range, 0.15e0.69). Post-SRT progression was defined as either PSA rising >0.2 ng/mL above nadir, or hormone treatment, or clinical recurrence. Data were analyzed with the Kaplan-Meier method (log-rank test) and with multivariate Cox regression. Results: The median follow-up was 5.9 years (maximum 14.4 years). In that time, 178 patients had recurrence and 30 men died. Univariate, a preRP PSA
