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Jackson WC, Desai NB, Abugharib AE, Tumati V, Dess RT, Lee JY, Zhao SG, Soliman M, Folkert M, Laine A, Hannan R, Zumsteg ZS, Sandler H, Hamstra DA, Montgomery JS, Miller DC, Kozminski MA, Hollenbeck BK, Hearn JW, Palapattu G, Tomlins SA, Mehra R, Morgan TM, Feng FY, Spratt DE. Anatomical patterns of recurrence following biochemical relapse after post-prostatectomy salvage radiation therapy: a multi-institutional study. BJU Int 2017; 120:351-357. [PMID: 28139024 DOI: 10.1111/bju.13792] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To characterise the frequency and detailed anatomical sites of failure for patients receiving post-radical prostatectomy (RP) salvage radiation therapy (SRT). PATIENTS AND METHODS A multi-institutional retrospective study was performed on 574 men who underwent SRT between 1986 and 2013. Anatomical recurrence patterns were classified as lymphotrophic (lymph nodes only), osteotrophic (bone only), or multifocal if both were present. Isolated first failure sites were defined as sites of initial clinically detected recurrence that remained isolated for at least 3 months. RESULTS The median follow-up after SRT was 6.8 years. The 8-year rates of local, regional, and distant failure for patients undergoing SRT were 2%, 6%, and 21%, respectively. Of the 22% men (128 of 574) who developed a clinically detectable recurrence, 17%, 50%, and 31% were lymphotrophic, osteotrophic, and multifocal, respectively. The trophic nature of metastases was prognostic for distant metastases-free survival (DMFS) and prostate cancer-specific survival (PCSS); the 10-year rates of DMFS were 18%, 5%, and 7% (P < 0.01), and PCSS were 78%, 68%, and 56% (P < 0.01), for lymphotrophic, osteotrophic, and multifocal failure patterns, respectively. CONCLUSIONS We demonstrate that trophism for metastatic site has significant prognostic impact on PCSS in men treated with SRT. Radiographic local failure is an uncommon event after SRT when compared to historical data of patients treated with surgery monotherapy. However, distant failure remains a challenge in this patient population and warrants further therapeutic investigation.
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Affiliation(s)
- William C Jackson
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Neil B Desai
- Department of Radiation Oncology, University of Texas Southwestern, Dallas, TX, USA
| | - Ahmed E Abugharib
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Vasu Tumati
- Department of Radiation Oncology, University of Texas Southwestern, Dallas, TX, USA
| | - Robert T Dess
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Jae Y Lee
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Shuang G Zhao
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Moaaz Soliman
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Michael Folkert
- Department of Radiation Oncology, University of Texas Southwestern, Dallas, TX, USA
| | - Aaron Laine
- Department of Radiation Oncology, University of Texas Southwestern, Dallas, TX, USA
| | - Raquibul Hannan
- Department of Radiation Oncology, University of Texas Southwestern, Dallas, TX, USA
| | - Zachary S Zumsteg
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Howard Sandler
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | | | - David C Miller
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Mike A Kozminski
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | | | - Jason W Hearn
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Ganesh Palapattu
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Scott A Tomlins
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Rohit Mehra
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Todd M Morgan
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Felix Y Feng
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA.,Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA
| | - Daniel E Spratt
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
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