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AUA 2017

AUA 2017: Critical Assessment of Radiotherapy Following Radical Prostatectomy: Timing of Radiotherapy, Recurrence, and Outcomes

Boston, MA (UroToday.com) The robot-assisted radical prostatectomy (RARP) remains the gold standard for the primary treatment of localized prostate cancer. Despite this, the debate for adjuvant radiation therapy as a concurrent treatment remains. Dr. Thomas Ahlering, from the University of California – Irvine, comments on the timing of radiation therapy (RT), biochemical recurrence rates and patient outcomes in a single, high-volume tertiary center.

Of the associations which publish guidelines to direct salvage and adjuvant radiation therapy, the National American Urological Association (AUA), European Association of Urology (EAU) and National Comprehensive Center (NCCN) are the most widely used. Of 1279 RARP patients from 2000 through 2013, Dr. Ahlering reports that the AUA and EAU both recommend adjuvant radiation therapy in over 20%. More surprisingly, approximately 29% of patients are recommended to adjuvant RT by the NCCN.

In lieu of these recommendations, Dr. Ahlering cites multiple studies favoring salvage radiation therapy at indication of progression by PSA doubling time. Utilizing this decision-making model, at a median follow-up of 7 years post-ARPP (84% of which had follow-up exceeding 2 years), 82% of the patients recommended by the NCCN had no evidence of disease at follow-up. The remaining 163 patients who had a biochemical recurrence at follow-up received adjuvant radiation therapy concurrent with androgen deprivation therapy. Finally, 27 were treated with salvage radiation therapy alone. Overall prostate-cancer specific mortality and overall mortality (1.42% and 4.65%, respectively) are similar to those reported in the literature.

Further, salvage RT appears to be highly cost-effective: following NCCN guidelines equates to an additional $10 million in radiotherapy costs in men with no subsequent biochemical recurrence. Given >80% in this NCCN group with no evidence of disease at follow-up, the risk of further progression is unlikely. As an alternative to adjuvant radiation therapy, salvage intervention appears to be similarly effective in the management of prostate cancer.

Presented by: Thomas Ahlering, MD, University of California, Irvine

Written By: Anthony Warner, a clinical research intern, from the University of California, Irvine, on behalf of UroToday.com.

at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA