Salvage radiotherapy SRT

A multi-institutional study suggests that early intervention with radiotherapy is better than delayed intervention for patients with biochemical failure [121, 122]. This analysis included patients with pT3-4N0 disease who received either SRT or early ART. Early ART for pT3-4N0 disease significantly reduces the risk of long-term biochemical progression after radical prostatectomy compared with SRT.

Stephenson et al. [123] reported on the outcomes and prognostic factors of 501 men who had salvage radiotherapy after a biochemical recurrence. In the entire cohort, the 4-year progression-free survival (PFS) was 45%, and 67% attained a PSA nadir of <0.1 ng/mL. Multivariate analyses demonstrated that Gleason score of 8 to 10, preradiotherapy PSA >2 ng/mL, negative margins, PSA-doubling time <10 months, and seminal vesicle invasion were associated with PSA progression. Supporting earlier intervention, preradiotherapy PSA <0.6 ng/mL had significantly improved PFS than a PSA of 0.61 to 2 ng/mL (P = 0.006) and >2 ng/mL (P = 0.001).

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