Ladislav Jarolím, Štěpán Veselý, Ivan Kawaciuk, Pavel Dušek, Lubomír Hyršl, Marek Schmidt, Jan Jerie, Pavel Hanek
Aim of study: Ultra-sensitive PSA assay (USPSA) allows detecting PSA at extremely low levels. We believe that the pattern of PSA growth in patients after radical prostatectomy (RP) enables to reveal local or systemic recurrence of the prostate cancer much earlier before the patients reach the conventional level of 0,2 ng/ml. In case of local recurrence this method facilitates the control over disease at an early stage when the chance of curative treatment is potentially still high. The aim of this study was to assess the efficacy of early salvage radiotherapy (RT) for patients with rising PSA below the conventional threshold of biochemical relapse. Methods: Between May 2005 and November 2007, fourteen patients were indicated to early salvage RT after RP for increasing PSA using USPSA in 3 moths’ interval. None of the patients had a history of hormonal treatment. Indication for the RT was a gradual PSA increase from a nadir PSA value under 0.1 ng/ml. Patients who reached the PSA value of 0.2 ng/ml during the first year after the surgery were not included in the study. RT was delivered to the prostatic bed (60 Gy) followed by boost at a total dose of 72-76 Gy. Regular PSA checks continued after RT. Results: Nadir PSA after RP ranked between 0.003 and 0.062 ng/ml. The time from the surgery to the indication of RT ranked between 9 and 24 months. The indication for RT was made at median of 0.14 ng/ml, mean 0.134 ng/ml (0.054-0.196 ng/ml). In four patients the RT was administered after exceeding the value of 0.2 ng/ml. Actual PSA value before RT was 0.054-0.307 ng/ml, median 0.174 and mean 0.180 ng/ml. The median value of PSA significantly (p < 0.0001) decreased from 0.174 (range 0.054-0.307) to 0.034 (0.010-0.209) at 3 months after RT. All the patients tolerated RT well with no serious side effects including mild temporary radiation proctitis and cystitis. Conclusion: Results of this study indicate that early referral for salvage RT based on growth patterns of USPSA values may effectively lower the PSA level in time when the patients did not reach the conventional threshold of biochemical recurrence yet.