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Optimal Definition of Biochemical Recurrence in Patients Who Receive Salvage Radiotherapy Following Radical Prostatectomy for Prostate Cancer

 Sung Uk Lee  ;  Jae-Sung Kim  ;  Young Seok Kim  ;  Jaeho Cho  ;  Seo Hee Choi  ;  Taek-Keun Nam  ;  Song Mi Jeong  ;  Youngkyong Kim  ;  Youngmin Choi  ;  Dong Eun Lee  ;  Won Park  ;  Kwan Ho Cho 
 CANCER RESEARCH AND TREATMENT, Vol.54(4) : 1191-1199, 2022-10 
Journal Title
Issue Date
Hormones ; Humans ; Male ; Neoplasm Recurrence, Local / surgery ; Prostate-Specific Antigen* ; Prostatectomy ; Prostatic Neoplasms* / pathology ; Prostatic Neoplasms* / radiotherapy ; Prostatic Neoplasms* / surgery ; Retrospective Studies ; Salvage Therapy
Purpose: This study proposed the optimal definition of biochemical recurrence (BCR) after salvage radiotherapy (SRT) following radical prostatectomy for prostate cancer.

Materials and methods: Among 1,117 patients who had received SRT, data from 205 hormone-naïve patients who experienced post-SRT prostate-specific antigen (PSA) elevation were included in a multi-institutional database. The primary endpoint was to determine the PSA parameters predictive of distant metastasis (DM). Absolute serum PSA levels and the prostate-specific antigen doubling time (PSA-DT) were adopted as PSA parameters.

Results: When BCR was defined based on serum PSA levels ranging from 0.4 ng/mL to nadir+2.0 ng/mL, the 5-year probability of DM was 27.6%-33.7%. The difference in the 5-year probability of DM became significant when BCR was defined as a serum PSA level of 0.8 ng/ml or higher (1.0-2.0 ng/mL). Application of a serum PSA level of ≥ 0.8 ng/mL yielded a c-index value of 0.589. When BCR was defined based on the PSA-DT, the 5-year probability was 22.7%-39.4%. The difference was significant when BCR was defined as a PSA-DT ≤ 3 months and ≤ 6 months. Application of a PSA-DT ≤ 6 months yielded the highest c-index (0.660). These two parameters complemented each other; for patients meeting both PSA parameters, the probability of DM was 39.5%-44.5%; for those not meeting either parameter, the probability was 0.0%-3.1%.

Conclusion: A serum PSA level > 0.8 ng/mL was a reasonable threshold for the definition of BCR after SRT. In addition, a PSA-DT ≤ 6 months was significantly predictive of subsequent DM, and combined application of both parameters enhanced predictability.
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1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
Yonsei Authors
Cho, Jae Ho(조재호) ORCID logo https://orcid.org/0000-0001-9966-5157
Choi, Seo Hee(최서희) ORCID logo https://orcid.org/0000-0002-4083-6414
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