Prostate Cancer–Specific Survival Following Salvage Radiotherapy vs Observation in Men With Biochemical Recurrence After Radical Prostatectomy

Abstract

Nearly 60 000 men (27% of newly diagnosed cases) will have undergone radical prostatectomy in 2007.¹ Although surgery provides excellent cancer control, approximately 15% to 40% of these men will experience cancer recurrence within 5 years,^2,3 usually manifested only by elevated prostate-specific antigen (PSA) level. It is currently difficult to determine whether increasing serum PSA level after surgery represents an isolated recurrence at the surgical site or occult metastases that cannot be detected by imaging. For such men it is unknown whether salvage radiotherapy confers a survival benefit compared with observation. Furthermore, it is unknown whether the likelihood of benefit differs for immediate vs delayed salvage radiotherapy, or among subgroups of men defined by pathological attributes. These are critical questions because 65% of men with biochemical or local recurrence will develop overt metastases if left untreated and the majority of these will die from their disease.⁴ No studies to date have evaluated the association of salvage radiotherapy with prostate cancer–specific survival.