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    Detectable PSA after RP warrants aggressive radiation


    Patients with detectable PSA after surgery (Arm C) experienced limited side effects as a result of radiation therapy, the researchers reported. Patients in Arm C did not report any grade 3 or grade 4 acute toxicities. Seven patients experienced severe late effects, with five patients reporting grade 3 bladder impairment, and two patients reporting grade 2 bladder impairment. Fifty patients (68%) in Arm C did not report any genitourinary late toxicity, and 59 patients (80%) in Arm C did not report any gastrointestinal late toxicity.

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    Clinical relapse-free survival was calculated using the Kaplan-Meier method. In Arm C, patients had a 10-year clinical relapse-free survival rate of 63%. Univariate analysis demonstrated that patients in Arm C who had a Gleason score <8 (p=.0023), pT <3b (p=.0076), or an extraprostatic tumor extension <2 mm (p=.0047) had a better relapse-free survival rate. 

    Using the Kaplan-Meier method to determine overall survival, patients in Arm A had a 10-year overall survival rate of 86%, and patients in Arm B had a 10-year overall survival rate of 83%. By comparison, those in Arm C had a 10-year overall survival of 68%.

    “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,” said lead study author Thomas Wiegel, MD, of University Hospital Ulm in Ulm, Germany.

    “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.”

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