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Benefits of early salvage therapy on oncological outcomes in high-risk prostate cancer with persistent PSA after radical prostatectomy

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Abstract

Background

Patients with prostate-specific antigen (PSA) persistence are at the increased risk of disease progression. The aim of our study was to evaluate the impact of early salvage therapy on oncological outcomes in patients with persistent PSA after radical prostatectomy (RP).

Methods

Within a single tertiary centre database, we identified men with persistent (≥ 0.1 ng/ml) versus undetectable (< 0.1 ng/ml) PSA 4–8 weeks after RP for high-risk prostate cancer (HRPCa). The cumulative incidence function was used to estimate cancer-specific survival (CSS) and clinical progression-free survival (CPFS). The Kaplan–Meier method was used to estimate overall survival (OS). The effects on oncological outcomes of salvage radiotherapy (SRT) ± androgen deprivation therapy (ADT) vs. ADT monotherapy were tested in the subgroup of patients with persistent PSA.

Results

Of 414 consecutive patients who underwent RP for HRPC, 125 (30.2%) had persistent PSA. Estimated 10-year CPFS, CSS and OS for men with persistent vs. undetectable PSA were 63.8% vs. 93.5%, 78.5% vs. 98.3% and 54% vs. 83.2% (all p < 0.0001), respectively. In men with persistent PSA, ADT alone was associated with higher risk (hazard ratio (HR) for worse CSS (HR 3.9, p = 0.005) and OS (HR 4.7, p < 0.0001) but not for CP (HR 1.6, p = 0.2) when compared with SRT ± ADT.

Conclusion

In patients who underwent RP for HRPCa, persistent PSA was associated with poor oncological outcomes. Early SRT ± ADT resulted in significantly improved CSS and OS in men with persistent PSA comparing with early androgen deprivation monotherapy.

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Acknowledgements

Steven Joniau is Senior Clinical Researcher of the FWO (Research Foundation Flanders)

Funding

No funding. The authors have no financial interest.

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Authors and Affiliations

  1. Medical Academy, Department of Urology, Lithuanian University of Health Sciences, A. Mickeviciaus 9, 44307, Kaunas, Lithuania

    D. Milonas & Z. Venclovas

  2. Leuven Biostatistics and Statistical Bioinformatics Center, KU Leuven, Oude Markt 13, 3000, Leuven, Belgium

    A. Laenen

  3. Medical Academy, Department of Oncology and Hematology, Lithuanian University of Health Sciences, A. Mickeviciaus 9, 44307, Kaunas, Lithuania

    L. Jarusevicius

  4. Department of Urology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium

    D. Milonas, G. Devos & S. Joniau

Authors
  1. D. Milonas
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  2. A. Laenen
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  3. Z. Venclovas
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  4. L. Jarusevicius
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  5. G. Devos
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  6. S. Joniau
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Contributions

DM: project development, data collection, data analysis, manuscript writing; AL: data analysis, manuscript editing; ZV: data collection, manuscript editing; LJ: data collection, manuscript editing; GD: manuscript editing; SJ: project development, manuscript editing.

Corresponding author

Correspondence to D. Milonas.

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The authors have no conflicts of interest.

Ethical approval

All procedures in this study involving human participants were in accordance with the ethical standards of the institutional committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Data collection and analysis was approved by the University ethical committee (BE-2–48).

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Milonas, D., Laenen, A., Venclovas, Z. et al. Benefits of early salvage therapy on oncological outcomes in high-risk prostate cancer with persistent PSA after radical prostatectomy. Clin Transl Oncol 24, 371–378 (2022). https://doi.org/10.1007/s12094-021-02700-y

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  • DOI: https://doi.org/10.1007/s12094-021-02700-y

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