A recent study published in the International Journal of Radiation Oncology • Biology • Physics (Red Journal) has shown that prostate cancer patients who have detectable prostate specific antigen (PSA) after undergoing radical prostatectomy should receive earlier and more aggressive radiation therapy treatment.
In this study, a research team led by Thomas Wiegel, MD, director of the radiation oncology department at University Hospital Ulm in Ulm, Germany, preformed a ten year post-treatment analysis of the German ARO 96-02 trial, which enrolled patients diagnosed with node negative prostate cancer who underwent prostatectomy.
This study assessed the benefits of a wait-and-see approach (arm A) versus an adjuvant radiation therapy approach (arm B). Moreover, the study reported the clinical outcome of patients who after 12 years of follow-up had persistent PSA post-radical prostatectomy and received aggressive radiotherapy (arm C).
A total of 388 patients with prostate cancer who received radical prostatectomy were recruited from 1997 to 2004. From the total 307 participants who achieved undetectable PSA levels, 159 patients were randomized to arm A and 148 to arm B. The remaining 74 patients that did not achieve undetectable PSA levels were assigned to complete arm C.
Using statistical analysis, the authors found that patients who had persisting PSA after radical prostatectomy also had higher preoperative PSA values, tumor stages, Gleason scores, and more positive surgical margins than patients in study arms A and B. Furthermore, compared with patients who had undetectable PSA levels, arm-C patients had worse clinical outcomes, with a 10-year relapse free survival rate of 67% versus 86% and 83% for arm A and arm B, respectively.
“After patients undergo radical prostatectomy, the marker for PSA should fall below detection limits. Our analysis demonstrates that patients who have detectable PSA post-prostatectomy may benefit from more aggressive, early and uniform treatment that could improve survival outcomes,” Dr. Wiegel said in a news release. “The impact of PSA persistence on 10-year overall survival is evident based on this new analysis. Improved imaging or surrogate markers beyond PSA are desirable to distinguish risk groups among men with PSA persistence. Larger, prospectively randomized clinical trials should examine additional treatment options to come to a standardized therapy for prostate cancer patients with PSA persistence.”