Early radiotherapy after radical prostatectomy improves cancer-specific survival only in patients with highly aggressive prostate cancer: Validation of recently released criteria - Abstract

OBJECTIVES: To test the effect of radiotherapy administered within 6 months after radical prostatectomy on cancer-specific mortality in prostate cancer patients after stratification according to a risk score.

METHODS: Overall, 7616 patients with pT3/4 N0/1 prostate cancer treated with radical prostatectomy between 1995 and 2009 within the Surveillance Epidemiology and End Results Medicare-linked database were included in the study. Competing-risks regression models were carried out to test the effect of early radiotherapy on cancer-specific mortality in the entire cohort, and after stratifying patients according to the risk score based on the number and nature of adverse pathological characteristics (Gleason score 8-10; pT3b/4, lymph node invasion).

RESULTS: The risk score was associated with increasing 5- and 10-year cancer-specific mortality rates (P < 0.001). When considering only patients with a risk score ≥ 2, 5- and 10-year cancer-specific mortality rates were significantly lower for individuals undergoing early radiotherapy compared with their counterparts not receiving early radiotherapy (2.9 and 6.9 vs 5.7 and 16.2%, respectively; P = 0.002). The corresponding number required to treat to prevent one death from prostate cancer at 10-year follow up was 10. Early radiotherapy was not associated with lower cancer-specific mortality rates overall and in patients with a risk score < 2. This was confirmed in multivariable analyses, where early radiotherapy decreased the risk of cancer-specific mortality only in patients with a risk score ≥ 2 (P ≤ 0.02).

CONCLUSIONS: The presence of two or more of the following pathological features might be used to identify patients who benefit from early radiotherapy: Gleason score 8-10, pT3b/4 and lymph node invasion.

Written by:
Gandaglia G, Karakiewicz PI, Briganti A, Trudeau V, Trinh QD, Kim SP, Montorsi F, Nguyen PL, Abdollah F, Sun M.   Are you the author?
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Department of Urology, Vita Salute San Raffaele University, Milan, Italy.

Reference: Int J Urol. 2014 Aug 21. Epub ahead of print.
doi: 10.1111/iju.12605

PubMed Abstract
PMID: 25141965

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