Time to second biochemical recurrence as a prognostic indicator in postprostatectomy patients who undergo salvage radiation therapy: An RTOG 9601 based post hoc analysis

Emily Chan Brodowsky; Akshay Sood; Mohit Butaney; Sami E Majdalany; Alex Stephens; Nicholas Corsi; Austin J Piontkowski; Ivan Rakic; Marcus Jamil; Deepansh Dalela; James O Peabody; Craig G Rogers; Firas Abdollah

doi:10.1002/pros.24436

Time to second biochemical recurrence as a prognostic indicator in postprostatectomy patients who undergo salvage radiation therapy: An RTOG 9601 based post hoc analysis

Prostate. 2023 Jan;83(1):64-70. doi: 10.1002/pros.24436. Epub 2022 Sep 19.

Authors

Emily Chan Brodowsky^{1

2}, Akshay Sood^{1

2

3}, Mohit Butaney¹, Sami E Majdalany¹, Alex Stephens¹, Nicholas Corsi⁴, Austin J Piontkowski⁴, Ivan Rakic⁴, Marcus Jamil^{1

2}, Deepansh Dalela^{1

2}, James O Peabody^{1

2}, Craig G Rogers^{1

2}, Firas Abdollah^{1

2}

Affiliations

¹ Department of Urology, VCORE-Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation, Henry Ford Hospital, Detroit, Michigan, USA.
² Department of Urology, Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan, USA.
³ Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
⁴ Division of Medicine, School of Medicine, Wayne State University, Detroit, Michigan, USA.

PMID: 36120850
DOI: 10.1002/pros.24436

Abstract

Introduction and objective: The prognostic significance of a "second" biochemical recurrence (sBCR) after salvage radiation therapy (sRT) with/without hormonal therapy following primary radical prostatectomy in men with prostate cancer has not been examined. We hypothesized that a shorter time to sBCR will be associated with worse cancer control outcomes.

Methods: The RTOG 9601 study included 760 patients with tumor stage pT2/T3, pN0, who had either persistently elevated prostate-specific antigen (PSA) postradical prostatectomy or developed subsequent biochemical recurrence with PSA levels between 0.2 and 4.0 ng/ml. All patients received sRT (with or without 2 years of Bicalutamide) from 1998 to 2015. For our study, we focused on 421 patients who had sBCR after sRT-which was defined as a PSA increase of at least 0.3 ng/ml over the first nadir. Patients were divided into two categories: early sBCR (n = 210) and late sBCR (n = 211) using median time to sBCR (3.51 years). All patients who experienced sBCR received salvage hormonal therapy. Competing-risk analysis was used to examine the impact of early versus late sBCR on prostate cancer specific mortality (CSM), after accounting for available covariates.

Results: The majority of patients were age 60 years or older (75.8%), had pT3 disease (74.8%), and Gleason score 7 (75.2%). Overall, 13.8% had persistent PSA initially after surgery. At 10 years, starting at the time of sBCR, CSM rate was 31.3% in the early sBCR group versus 20.0% in the late sBCR group. In competing-risk analysis, time to sBCR was an independent predictor of CSM, where patients with early sBCR had 1.7-fold higher CSM risk (p = 0.026) than their counterparts with late sBCR.

Conclusions: Time to sBCR after sRT (with or without concomitant Bicalutamide) is a significant predictor of CSM following initial radical prostatectomy. This information can be used to guide subsequent treatments, and to counsel patients.

Trial registration: ClinicalTrials.gov NCT00002874.

Keywords: prostate cancer; salvage radiation therapy; second biochemical recurrence.

MeSH terms

Humans
Male
Middle Aged
Prognosis
Prostatic Neoplasms* / radiotherapy
Prostatic Neoplasms* / surgery

Associated data

ClinicalTrials.gov/NCT00002874