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Anatomical patterns of recurrence following biochemical relapse after post-prostatectomy salvage radiation therapy: a multi-institutional study.

  • Jackson, William C1
  • Desai, Neil B2
  • Abugharib, Ahmed E1
  • Tumati, Vasu2
  • Dess, Robert T1
  • Lee, Jae Y1
  • Zhao, Shuang G1
  • Soliman, Moaaz1
  • Folkert, Michael2
  • Laine, Aaron2
  • Hannan, Raquibul2
  • Zumsteg, Zachary S3
  • Sandler, Howard3
  • Hamstra, Daniel A4
  • Montgomery, Jeffrey S5
  • Miller, David C5
  • Kozminski, Mike A5
  • Hollenbeck, Brent K5
  • Hearn, Jason W1
  • Palapattu, Ganesh5
  • And 5 more
  • 1 Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA.
  • 2 Department of Radiation Oncology, University of Texas Southwestern, Dallas, TX, USA.
  • 3 Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
  • 4 The Texas Center for Proton Therapy, Irving, TX, USA.
  • 5 Department of Urology, University of Michigan, Ann Arbor, MI, USA.
  • 6 Department of Pathology, University of Michigan, Ann Arbor, MI, USA.
  • 7 Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA.
Published Article
British Journal of Urology
Wiley (Blackwell Publishing)
Publication Date
Sep 01, 2017
DOI: 10.1111/bju.13792
PMID: 28139024


To characterise the frequency and detailed anatomical sites of failure for patients receiving post-radical prostatectomy (RP) salvage radiation therapy (SRT). 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. 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. 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. © 2017 The Authors BJU International © 2017 BJU International Published by John Wiley & Sons Ltd.

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