The possibility of hormone-mediated PSA derangement in prostate cancer treatment

Background: This study was designed to suggest the possibility of hormone-related derangement in salvage radiotherapy (SRT) a er radical prostatectomy in terms of prostate-specific an gen (PSA) control. Materials and Methods: Among 160 consecu ve prostate cancer pa ents who received radical prostatectomy, 34 with SRT between 2004 and 2012 were retrospec vely reviewed. The numbers of pa ents with pathologic T3-T4 stage, Gleason score 8-10, and posi ve resec on margin were 11 (32.4%), 10 (29.4%), and 17 (50.0%), respec vely. Median SRT dose was 64.8 Gy (range, 52.9-70.0 Gy) with 1.8-2.3 Gy frac ona ons. Biochemical failure -free survival a er SRT was counted and the median follow-up period was 32.5 months (range, 10-118 months). Results: A er SRT, the median me for PSA to decrease to less than 0.2 ng/mL was four months (range, 0-25 months). The three-year survival rate was 60.3%. On univariate analysis, preferen al hormone therapy (PHT) (p=0.022), higher PSA at SRT (p=0.005), and higher PSA a er surgery (p=0.003) were related to a shorter biochemical survival period. On mul variate analysis, lower PSA at SRT (p=0.016), higher radia on dose (p=0.007), and non-PHT (p=0.046) suggested a consistent PSA control. Conclusion: According to these results, low PSA values by hormonal interven on need to be reconsidered with a different way to look at the rela onship between the PSA and hormone therapy. SRT should be considered for postopera ve salvage treatment regardless of the hormone-related PSA values.