Abstract
Salvage radiation therapy is the sole curative treatment for patients experiencing biochemical relapse after radical surgical treatment of prostate cancer. The main dilemma in salvage radiation therapy is, whether or not biochemical relapse represents purely localized recurrent disease in the prostatic fossa or systemic micrometastasis. Initiating salvage radiation therapy at an early time point raises its chances of success, but may lead to overtreatment of patients. Target volume definition and treatment techniques are a matter of current research, with still many questions unanswered. Strategies of treatment escalation either by increasing the treatment dose or combining radiation therapy with androgen deprivation therapy are being addressed in clinical trials.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
A phase III randomized trial of MRI-mapped dose-escalated salvage radiotherapy post-prostatectomy: the MAPS trial. http://www.clinicaltrials.gov/ct2/show/NCT01411345. Accessed 26 Nov 2012
Alongi F, Fiorino C, Cozzarini C et al (2009) IMRT significantly reduces acute toxicity of whole-pelvis irradiation in patients treated with post-operative adjuvant or salvage radiotherapy after radical prostatectomy. Radiother Oncol 93(2):207–212
Amling CL, Blute ML, Bergstralh EJ et al (2000) Long-term hazard of progression after radical prostatectomy for clinically localized prostate cancer: continued risk of biochemical failure after 5 years. J Urol 164:101–105
Bolla M, van Poppel H, Collette L et al (2005) Postoperative radiotherapy after radical prostatectomy: a randomised controlled trial (EORTC trial 22911). Lancet 366:572–578
Boorjian SA, Karnes RJ, Crispen PL et al (2009) Radiation therapy after radical prostatectomy: impact on metastasis and survival. J Urol 182(6):2708–2714
Buskirk SJ, Pisansky TM, Schild SE et al (2006) Salvage radiotherapy for isolated prostate specific antigen increase after radical prostatectomy: evaluation of prognostic factors and creation of a prognostic scoring system. J Urol 176(3):985–990
Cher ML, Bianco FJ Jr, Lam JS et al (1998) Limited role of radionuclide bone scintigraphy in patients with prostate specific antigen elevations after radical prostatectomy. J Urol 160(4):1387
Choo R, Danjoux C, Gardner S et al (2009) Efficacy of salvage radiotherapy plus 2-year androgen suppression for postradical prostatectomy patients with PSA relapse. Int J Radiat Oncol Biol Phys 75(4):983–989
Corn BW, Winter K, Pilepich MV (1999) Does androgen suppression enhance the efficacy of postoperative irradiation? A secondary analysis of RTOG 85-31 Radiation Therapy Oncology Group. Urology 54(3):495–502
Cotter SE, Chen MH, Moul JW (2011) Salvage radiation in men after prostate-specific antigen failure and the risk of death. Cancer 117(17):3925–3932
Da Pozzo LF, Cozzarini C, Briganti A et al (2009) Long-term follow-up of patients with prostate cancer and nodal metastases treated by pelvic lymphadenectomy and radical prostatectomy: the positive impact of adjuvant radiotherapy. Eur Urol 55(5):1003–1011
Dearnaley DP, Khoo VS, Norman AR et al (1999) Comparison of radiation side-effects of conformal and conventional radiotherapy in prostate cancer: a randomised trial. Lancet 353(9149):267–272
Digesú C, Cilla S, De Gaetano A et al. (2011) Postoperative intensity modulated radiation therapy in high risk prostate cancer: a dosimetric comparison. Med Dosim 36(3):231–239 (Autumn)
European Urology Association Guidelines on Prostate Cancer (2012). http://www.uroweb.org/gls/pdf/08%20Prostate%20Cancer_LR%20March%2013th%202012.pdf. Accessed 26 Nov 2012
Feng M, Hanlon AL, Pisansky TM (2007) Predictive factors for late genitourinary and gastrointestinal toxicity in patients with prostate cancer treated with adjuvant or salvage radiotherapy. Int J Radiat Oncol Biol Phys 68(5):1417–1423
Geinitz H, Riegel MG, Thamm R et al (2012) Outcome after conformal salvage radiotherapy in patients with rising prostate-specific antigen levels after radical prostatectomy. Int J Radiat Oncol Biol Phys 82(5):1930–1937
Giannarini G, Nguyen DP, Thalmann GN et al (2012) Diffusion-weighted magnetic resonance imaging detects local recurrence after radical prostatectomy: initial experience. Eur Urol 61(3):616–620
Goenka A, Magsanoc JM, Pei X et al (2011) Improved toxicity profile following high-dose post prostatectomy salvage radiation therapy with intensity-modulated radiation therapy. Eur Urol 60(6):1142–1148
Graute V, Jansen N, Ubleis C et al (2012) Relationship between PSA kinetics and (18F) fluorocholine PET/CT detection rates of recurrence in patients with prostate cancer after total prostatectomy. Eur J Nucl Med Mol Imag 39(2):271–282
Han M, Partin AW, Zahurak M et al (2003) Biochemical (prostate specific antigen) recurrence probability following radical prostatectomy for clinically localized prostate cancer. J Urol 169:517–523
Huch Böni RA, Meyenberger C, Pok Lundquist J et al. (1996) Value of endorectal coil versus body coil MRI for diagnosis of recurrent pelvic malignancies. Abdom Imag 21(4):345–352
Katz MS, Zelefsky MJ, Venkatraman ES et al (2003) Predictors of biochemical outcome with salvage conformal radiotherapy after radical prostatectomy for prostate cancer. J Clin Oncol 21(3):483–489
King CR (2012) The timing of salvage radiotherapy after radical prostatectomy: a systematic review. Int J Radiat Oncol Biol Phys 84(1):104–111
King CR, Kapp DS (2008) Radiotherapy after prostatectomy: is the evidence for dose escalation out there? Int J Radiat Oncol Biol Phys 71:346–350
King CR, Spiotto MT (2008) Improved outcomes with higher doses for salvage radiotherapy after prostatectomy. Int J Radiat Oncol Biol Phys 71:23–27
King CR, Presti JC Jr, Gill H et al (2004) Radiotherapy after radical prostatectomy: does transient androgen suppression improve outcomes? Int J Radiat Oncol Biol Phys 59(2):341–347
Kupelian PA, Katcher J, Levin HS, Klein EA (1997) Stage T1-prostate cancer: a multivariate analysis of factors affecting biochemical and clinical failures after radical prostatectomy. Int J Radiat Oncol Biol Phys 37:1043–1052
Lawton CA, DeSilvio M, Roach M 3rd et al (2007) An update of the phase III trial comparing whole pelvic to prostate only radiotherapy and neoadjuvant to adjuvant total androgen suppression: updated analysis of RTOG 94-13, with emphasis on unexpected hormone/radiation interactions. Int J Radiat Oncol Biol Phys 69(3):646–655
Liauw SL, Pitroda SP, Eggener SE et al. (2012) Evaluation of the prostate bed for local recurrence after radical prostatectomy using endorectal magnetic resonance imaging. Int J Radiat Oncol Biol Phys 85:378–384
Macdonald OK, D’Amico AV, Sadetsky N et al. (2008) Predicting PSA failure following salvage radiotherapy for a rising PSA post-prostatectomy: from the CaPSURE database. Urol Oncol 26(3):271–275
Meerleer GD, Fonteyne V, Meersshout S et al (2008) Salvage intensity-modulated radiotherapy for rising PSA after radical prostatectomy. Radiother Oncol 89:205–213
Meng MV, Shinohara K, Grossfeld GD, Carroll PR (2002) Local therapy for recurrent prostate cancer. In: Kantoff PW, Carroll PR, D’Amico AV (eds) Prostate cancer: principles and practice, pp 307–316. Lippincott Williams and Wilkins, Philadelphia
Michalski J, Lawton C, El Naqa I et al (2010) Development of RTOG consensus guidelines for the definition of the clinical target volume for postoperative conformal radiation therapy for prostate cancer. Int J Radiat Oncol Biol Phys 76(2):361–368
Nath SK, Sandhu AP, Rose BS et al (2010) Toxicity analysis of postoperative image-guided intensity-modulated radiotherapy for prostate cancer. Int J Radiat Oncol Biol Phys 78(2):435–441
NCCN (2012) Clinical practice guidelines in oncology: prostate cancer version 3.2012. http://www.nccn.org/professionals/physician_gls/pdf/prostate.pdf. Accessed on 26 Nov 2012
Neuhof D, Hentschel T, Bischof M et al (2007) Long-term results and predictive factors of three-dimensional conformal salvage radiotherapy for biochemical relapse after prostatectomy. Int J Radiat Oncol Biol Phys 67:1411–1417
Nguyen PL, Je Y, Schutz FA et al (2011) Association of androgen deprivation therapy with cardiovascular death in patients with prostate cancer: a meta-analysis of randomized trials. JAMA 306(21):2359–2366
Ohri N, Dicker AP, Trabulsi EJ et al (2012a) Can early implementation of salvage radiotherapy for prostate cancer improve the therapeutic ratio? A systematic review and regression meta-analysis with radiobiological modelling. Eur J Cancer 48(6):837–844
Ohri N, Dicker AP, Trabulsi EJ et al (2012b) Can early implementation of salvage radiotherapy for prostate cancer improve the therapeutic ratio? A systematic review and regression meta-analysis with radiobiological modelling. Eur J Cancer 48(6):837–844
Paul R, Hoppmann M, van Randenborgh H et al (2004) Residual benign prostatic glands at the urethrovesical anastomosis after radical retropubic prostatectomy: prediction and impact on disease outcome. Eur Urol 46(3):321–326
Pazona JF, Han M, Hawkins SA et al (2005) Salvage radiation therapy for prostate specific antigen progression following radical prostatectomy: 10-year outcome estimates. J Urol 174(4 Pt 1):1282–1286
Pearse M, Choo R, Danjoux C et al (2008) Prospective assessment of gastrointestinal and genitourinary toxicity of salvage radiotherapy for patients with prostate-specific antigen relapse or local recurrence after radical prostatectomy. Int J Radiat Oncol Biol Phys 72(3):792–798
Picchio M, Briganti A, Fanti S et al (2011) The role of choline positron emission tomography/computed tomography in the management of patients with prostate-specific antigen progression after radical treatment of prostate cancer. Eur Urol 59(1):51–60
Pisansky TM, Kozelsky TF, Myers RP et al (2000) Radiotherapy for isolated serum prostate specific antigen elevation after prostatectomy for prostate cancer. J Urol 163(3):845–850
Pommier P, Chabaud S, Lagrange JL et al (2007) Is there a role for pelvic irradiation in localized prostate adenocarcinoma? Preliminary results of GETUG-01. J Clin Oncol 25(34):5366–5373
Poortmans P, Bossi A, Vandeputte K et al (2007) Guidelines for target volume definition in post-operative radiotherapy for prostate cancer, on behalf of the EORTC Radiation Oncology Group. Radiother Oncol 84(2):121–127
Pound CR, Partin AW, Eisenberger MA et al (1999) Natural history of progression after PSA elevation following radical prostatectomy. JAMA 281:1591–1597
Prostate radiation therapy or short-term androgen deprivation therapy and pelvic lymph node radiation therapy with or without prostate radiation therapy in treating patients with a rising PSA after surgery for prostate cancer. http://clinicaltrials.gov/show/NCT00567580 Accessed 26 Nov 2012
Radiation therapy and androgen deprivation therapy in treating patients who have undergone surgery for prostate cancer (RADICALS). http://clinicaltrials.gov/show/NCT00541047. Accessed 26 Nov 2012
Radiation therapy in treating patients with relapsed prostate cancer after surgery. http://clinicaltrials.gov/show/NCT01272050. Accessed 26 Nov 2012
Radiation therapy with or without Goserelin in treating patients who have undergone surgery for recurrent or refractory prostate cancer. http://clinicaltrials.gov/show/NCT00423475. Accessed 26 Nov 2012
Radiation therapy with or without hormone therapy in treating patients who have undergone surgery for stage I, stage II, or stage III prostate cancer. http://www.clinicaltrials.gov/ct2/show/NCT00949962. Accessed 26 Nov 2012
Radiotherapy—Adjuvant Versus Early Salvage (RAVES). http://www.clinicaltrials.gov/ct2/show/NCT00860652. Accessed 26 Nov 2012
Riou O, Laliberte B, Azria D et al. (2012) Implementing intensity modulated radiotherapy to the prostate bed: dosimetric study and early clinical results. Med Dosim pii: S0958-3947 (12) 00167-7
RTOG (2012) Pelvic lymph node volumes for prostate cancer atlas. http://www.rtog.org/LinkClick.aspx?fileticket=glmTGKHTmr0%3d&tabid=234. Accessed 26 Nov 2012
Schild SE, Wong WW, Novicki DE et al (1996) Detection of residual prostate cancer after radical prostatectomy with the Abbott IMx PSA assay. Urology 47(6):878–881
Sciarra A, Panebianco V, Salciccia S et al (2008) Role of dynamic contrast-enhanced magnetic resonance (MR) imaging and proton MR spectroscopic imaging in the detection of local recurrence after radical prostatectomy for prostate cancer. Eur Urol 54(3):589–600
Sciarra A, Panebianco V, Ciccariello M et al (2010) Value of magnetic resonance spectroscopy imaging and dynamic contrast-enhanced imaging for detecting prostate cancer foci in men with prior negative biopsy. Clin Cancer Res 16(6):1875–1883
Shah O, Melamed J, Lepor H (2001) Analysis of apical soft tissue margins during radical retropubic prostatectomy. J Urol 165(6 Pt 1):1943–1948
Sheets NC, Goldin GH, Meyer AM et al (2012) Intensity-modulated radiation therapy, proton therapy, or conformal radiation therapy and morbidity and disease control in localized prostate cancer. JAMA 307(15):1611–1620
Shipley WU, Hunt D, Lukka HR et al. (2011) Initial report of RTOG 9601, a phase III trial in prostate cancer: effect of anti-androgen therapy (AAT) with bicalutamide during and after radiation therapy (RT) on freedom from progression and incidence of metastatic disease in patients following radical prostatectomy (RP) with pT2-3, N0 disease and elevated PSA levels. J Clin Oncol 29 (suppl 7; abstr 1)
Slovin SF, Wilton AS, Heller G, Scher HI (2005) Time to detectable metastatic disease in patients with rising prostate-specific antigen values following surgery or radiation therapy. Clin Cancer Res 11:8669–8673
Spiotto MT, Hancock SL, King CR (2007) Radiotherapy after prostatectomy: improved biochemical relapse-free survival with whole pelvic compared with prostate bed only for high-risk patients. Int J Radiat Oncol Biol Phys 69(1):54–61
Stephenson AJ, Shariat SF, Zelefsky MJ et al (2004) Salvage radiotherapy for recurrent prostate cancer after radical prostatectomy. JAMA 291:1325–1332
Stephenson AJ, Scardino PT, Kattan MW et al (2007) Predicting the outcome of salvage radiation therapy for recurrent prostate cancer after radical prostatectomy. J Clin Oncol 25:2035–2041
Taylor N, Kelly JF, Kuban DA et al (2003) Adjuvant and salvage radiotherapy after radical prostatectomy for prostate cancer. Int J Radiat Oncol Biol Phys 56(3):755–763
Thompson IM Jr, Tangen CM, Paradelo J et al (2006) Adjuvant radiotherapy for pathologically advanced prostate cancer: a randomized clinical trial. JAMA 296:2329–2335
Thompson IM, Tangen CM, Paradelo J et al (2009) Adjuvant radiotherapy for pathological T3N0M0 prostate cancer significantly reduces risk of metastases and improves survival: long-term followup of a randomized clinical trial. J Urol 181:956–962
Tiguert R, Rigaud J, Lacombe L et al (2003) Neoadjuvant hormone therapy before salvage radiotherapy for an increasing post-radical prostatectomy serum prostate specific antigen level. J Urol 170(2 Pt 1):447–450
Tongco WP, Wehner MS, Basler JW (2001) Does urethral-sparing prostatectomy risk residual prostate cancer? Urology 57(3):495–498
Trial to evaluate radiotherapy followed by endocrine therapy vs endocrine therapy alone for PSA failure after radical prostatectomy. http://clinicaltrials.gov/show/NCT00138008. Accessed on 26 Nov 2012
Trock BJ, Han M, Freedland SJ et al (2008) Prostate cancer-specific survival following salvage radiotherapy vs observation in men with biochemical recurrence after radical prostatectomy. JAMA 299(23):2760–2769
Viani GA, Stefano EJ, Afonso SL (2009) Higher-than-conventional radiation doses in localized prostate cancer treatment: a meta-analysis of randomized, controlled trials. Int J Radiat Oncol Biol Phys 74:1405–1418
Ward JF, Moul JW (2005) Rising prostate-specific antigen after primary prostate cancer therapy. Nat Clin Pract Urol 2:174–182
Ward JF, Zincke H, Bergstralh EJ et al (2004) Prostate specific antigen doubling time subsequent to radical prostatectomy as a prognosticator of outcome following salvage radiotherapy. J Urol 172(6 Pt 1):2244–2248
Wiegel T, Bottke D, Bandlow P et al (2002) The value of PSA measurements at 30 Gy, 50 Gy and 60 Gy for dose limitation in patients with radiotherapy for PSA increase after radical prostatectomy. Strahlenther Onkol 178(8):422–425
Wiegel T, Bottke D, Steiner U et al (2009a) Phase III postoperative adjuvant radiotherapy after radical prostatectomy compared with radical prostatectomy alone in pT3 prostate cancer with postoperative undetectable prostate-specific antigen: ARO 96-02/AUO AP 09/95. J Clin Oncol 27:2924–2930
Wiegel T, Lohm G, Bottke D et al (2009b) Achieving an undetectable PSA after radiotherapy for biochemical progression after radical prostatectomy is an independent predictor of biochemical outcome–results of a retrospective study. Int J Radiat Oncol Biol Phys 73(4):1009–1016
Conflict of Interest Notification
The authors have no actual or potential conflict of interest related to this review. There are no financial disclosures from any author.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2013 Springer-Verlag Berlin Heidelberg
About this chapter
Cite this chapter
Papachristofilou, A., Ghadjar, P., Zimmermann, F. (2013). Salvage Radiotherapy After Radical Prostatectomy. In: Geinitz, H., Roach III, M., van As, N. (eds) Radiotherapy in Prostate Cancer. Medical Radiology(). Springer, Berlin, Heidelberg. https://doi.org/10.1007/174_2013_939
Download citation
DOI: https://doi.org/10.1007/174_2013_939
Published:
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-642-37098-4
Online ISBN: 978-3-642-37099-1
eBook Packages: MedicineMedicine (R0)