Trock BJ et al. (2008) Prostate cancer specific survival following salvage radiotherapy vs observation in men with biochemical recurrence after radical prostatectomy. JAMA 299: 2760–2769

Although radical prostatectomy can control prostate cancer in the majority of newly diagnosed cases, many individuals experience biochemical recurrence within 5 years and require salvage radiotherapy. The association between salvage radiotherapy and prostate-cancer-specific survival has not been evaluated to date. Trock and co-workers have assessed prostate cancer-specific survival following salvage radiotherapy in men who experienced biochemical recurrence.

Data from a cohort of 635 men who underwent prostatectomy during the period 1982–2004 and experienced biochemical recurrence were retrospectively analyzed. Of these men, 397 received no salvage treatment, 160 received salvage radiotherapy, and 78 received salvage radiotherapy combined with hormonal therapy.

At a median follow-up of 6 years from the time of recurrence, a total of 116 men had died from prostate cancer. Salvage radiotherapy alone or combined with hormonal therapy was associated with significantly longer prostate-cancer-specific survival and overall survival than no salvage treatment. Improved survival was confined to men with a prostate-specific antigen (PSA) doubling time of less than 6 months and remained significant after adjustment for Gleason score, postoperative stage, and time to initial PSA recurrence.

The authors conclude that early salvage radiotherapy is associated with improved survival in men with biochemical disease recurrence after radical prostatectomy. These results need to be validated in other settings, however, particularly since results from a recently initiated European clinical trial comparing salvage radiotherapy with adjuvant radiotherapy will not be available for many years.