BETHESDA, MD USA (UroToday.com) - Dr. Ronald Chen framed his talk by describing the 3 types of patients after radical prostatectomy: those with localized disease, locally advanced disease, and those with pathological node-positive (N+) disease. In the locally advanced patients, although RCTs have shown support for radiotherapy (XRT), there is still debate about timing of treatment and overall survival benefit. However, in N+ patients, adjuvant XRT may make more sense according to Dr. Chen. He drew a juxtaposition between N1 and M1 disease: both are considered clinical stage IV patients, but patients may have different clinical outcomes. Current NCCN guidelines recommend observation for post-prostatectomy N+ patients, androgen-deprivation therapy (ADT), or ADT+XRT. The only recommendation of these 3, however, which is based on level 1 data is ADT (the Messing trial). In support of ADT+XRT, he highlighted Italian data combining data from 2 institutions retrospectively where > 300 patients had N+ disease after prostatectomy. Patients who underwent RP underwent either ADT or ADT+XRT. Matched analysis showed that addition of adjuvant XRT to ADT increased survival, with some patients having durable responses. Both OS and CSS was improved, especially in patients with > 2 positive nodes.
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A second study, which is in press, subdivided > 1 000 N+ patients after prostatectomy with < 2 positive nodes vs ≥ 2, then subdivided those with ≥ 2 to again show that ADT+XRT may have an increased survival benefit.
In conclusion, he reiterated that the data, although retrospective, is hypothesis-generating, then mentioned that cooperative oncology groups can perform the clinical trials required to really convince us that such therapy is beneficial; these groups will probably be necessary given the low frequency of finding node-positive patients in the current era.
Ronald Chen, MD, MPH
University of North Carolina
Philip Abbosh, MD, PhD* from the 2014 Winter Meeting of the Society of Urologic Oncology (SUO) "Defining Excellence in Urologic Oncology" - December 3 - 5, 2014 - Bethesda, MD USA
*Fox Chase Cancer Center, Philadelphia, PA USA