Mohamed Shelan, Abstract Co-Author: Nothing to Disclose

Markus Bohrer, Abstract Co-Author: Nothing to Disclose

Julia Kosakowski, Abstract Co-Author: Nothing to Disclose

Nadim Behnam, Abstract Co-Author: Nothing to Disclose

Frederik Wenz, Abstract Co-Author: Nothing to Disclose

Yasser Abo Madyan, Presenter: Nothing to Disclose

Purpose/Objective(s): Evaluation of the efficacy of radiotherapy (RT) after radical prostatovesiculectomy whether received in adjuvant or salvage setting, to determine prognostic factors identifying patients who may benefit from salvage RT.Materials/Methods: We conducted a single-institution retrospective review of patients who received postoperative radiotherapy after radical prostatectomy at the department of radiation oncology, University Medical Center Mannheim, Heidelberg University inclusive 2002-2008. Identified were 138 patients with median age of 63.5 years, median preoperative PSA=8.9 ng/ml, 60% with Gleason Score 7 or less and 40% with Gleason Score more than 7. Most patients (116 patients) received salvage radiotherapy due to postoperative PSA relapse ± evidence of local recurrence, while 22 patients received adjuvant radiotherapy due to positive margins in surgical specimens. Radiation therapy was delivered to the fossa of the prostate (median dose 70Gy) and fossa of seminal vesicles (median dose 66Gy) ± pelvic lymph nodes (in only 11.6% of the patients, median dose 44Gy) using 3D conformal radiotherapy alone (33.3%) or in combination with IMRT (66.7%). The biochemical failure after RT was defined as an increase of the serum PSA value more than 0.2 ng/ml above the post-irradiation nadir value confirmed by a second elevation.Results: The 7 years overall survival was 94.2%. At a median follow up of 40 months after radiation, the biochemical control rate and metastasis free survival (MFS) were 56% and 85% respectively. For the adjuvant RT group the biochemical control rate was 71% compared 52.7% for the salvage RT group (p=0.034), respectively, the MFS was 86.8% compared to 84.6% (p=0.75).Pre-irradiation PSA value was a significant prognostic factor for the salvage group as the biochemical control rate for patients whose pre-radiation PSA less than or equal 1ng/ml was 60 % and 36% for those with pre-irradiation PSA more than 1ng/ml (p=0.004), respectively, the MFS was 86.5% compared to 77.7% (p=0.23).Conclusion: Adjuvant RT seems to provide a more effective biochemical control after radical prostatectomy than salvage RT with no obvious effect on the rate of distant metastasis. Early Salvage RT with PSA values still less than or equal 1ng/ml provides significantly better biochemical control than late salvage RT with PSA value more than 1ng/ml. This however appears to have smaller influence on the incidence of distant metastasis.

Shelan, M, Bohrer, M, Kosakowski, J, Behnam, N, Wenz, F, Abo Madyan, Y, Treatment Outcome of High-Dose Adjuvant and Salvage Radiotherapy after Radical Prostatectomy.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11034671.html