Initiating Salvage RT When PSA >0.25 ng/mL Linked to All-Cause Mortality

FRIDAY, March 31, 2023 (HealthDay News) — For men with one high-risk factor, initiating post-radical prostatectomy salvage radiation therapy (sRT) when prostate-specific antigen (PSA) levels are greater than 0.25 ng/mL is associated with an increased risk for all-cause mortality (ACM), according to a study published online March 1 in the Journal of Clinical Oncology.

Derya Tilki, M.D., from University Hospital Hamburg-Eppendorf in Germany, and colleagues used data from a multinational database of 25,551 patients with pT2-4N0 or NXM0 prostate cancer to examine whether there was a significant increase in ACM risk when sRT was delivered above a prespecified PSA level, from 0.10 ng/mL and increasing in 0.05 increments up to 0.50 ng/mL.

The researchers found that the risk for ACM was significantly higher for patients who received sRT at a PSA level >0.25 ng/mL compared with PSA ≤0.25 ng/mL, after a median follow-up of 6.00 years (adjusted hazard ratio, 1.49). The elevated ACM risk was significant for all PSA cutpoints up to 0.50 ng/mL, but not below 0.25 ng/mL.

“The clinical relevance of this finding is that some physicians are waiting until the PSA level exceeds 0.25 ng/mL in the post-radical prostatectomy setting to obtain a prostate-specific membrane antigen positron emission tomography scan and then initiate salvage treatment,” the authors write. “The results of the current study provide evidence to support that by waiting to initiate sRT after PSA failure may place some patients at increased ACM risk.”

Several authors disclosed financial ties to the biopharmaceutical industry.