Background and purpose: To assess the efficacy of salvage radiotherapy (RT) for biopsy confirmed or clinically palpable local recurrence of prostate adenocarcinoma after radical prostatectomy (RP).
Patients and methods: We retrospectively analyzed 44 patients treated with salvage RT for biopsy confirmed or clinically palpable local recurrence between 1991 and 2000. Thirty-six had positive biopsy for local recurrence and the rest without histological confirmation had clinically palpable disease. All had rising PSA at the time of RT (median: 3.7). Median interval from RP to RT was 2.6 years. Thirty-six received salvage RT alone, while eight had a short course (<4 months) of androgen ablation prior to RT. RT doses were 60-66Gy in 30-33 fractions. Freedom from PSA failure was defined as the maintenance of PSA<or=0.2.
Results: Median follow-ups from RP and salvage RT were 8.7 and 5.5 years, respectively. All but one achieved local control clinically. The actuarial PSA relapse-free and survival rate at 5 years were 11 and 87%, respectively. On Cox regression analysis, significant predictors for relapse were PSA level prior to salvage RT, and Gleason score.
Conclusions: The efficacy of salvage RT alone for local recurrence was limited. This study suggests a need to explore other strategies incorporating systemic therapy, and the importance of timely referral for consideration of salvage RT in patients with rising PSA after surgery.