Post-operative radiation therapy for patients at high-risk of recurrence after radical prostatectomy: Does timing matter? - Abstract

OBJECTIVE: To evaluate among prostatectomy patients at high-risk of recurrence whether the timing of post-operative radiation therapy (adjuvant, early salvage with detectable post-prostatectomy PSA, or "late" salvage with PSA>1.0) significantly is associated with overall, prostate-cancer specific or metastasis-free survival, in a longitudinal cohort.

PATIENTS AND METHODS: Of 6176 prostatectomy patients in the Cancer of the Prostate Strategic Urologic Research Endeavor(CaPSURE), 305 patients with high-risk pathologic features(margin positivity, Gleason Score(pGS) 8-10, or pT3-T4) who underwent post-operative radiation were examined, either in the adjuvant(≤ 6 months from surgery with undetectable PSA, N=76) or salvage setting(>6 months after surgery or pre-radiation PSA>0.1, N=229). Early (PSA≤ 1.0, N=180) or late salvage radiation(PSA>1.0, N=49) was based on post-prostatectomy, pre-radiation PSA. Multivariable Cox regression examined associations with all-cause mortality and prostate cancer-specific mortality or metastases(PCSMM).

RESULTS: After a median of 74 months from prostatectomy, 65 men died(with 37 events of PCSMM). Adjuvant and salvage radiation patients had comparable high-risk features. Compared to adjuvant, salvage radiation(early or late) had an increased association with all-cause mortality(hazard ratio[HR] 2.7, p=0.018) and with PCSM(HR 4.0, p=0.015). PCSM-free survival differed by further stratification of timing, with 10-year estimates of 88%, 84%, and 71% for adjuvant, early salvage, and late salvage radiation, respectively(P=0.026). For PCSM- and overall-survival, compared to adjuvant RT, late salvage RT had statistically significantly increased risk, however early salvage RT did not.

CONCLUSION: This analysis suggests that patients who underwent early salvage radiation with PSA< 1.0 may have comparable metastasis-free and overall-survival compared with adjuvant RT; however, late salvage radiation with a PSA>1.0 is associated with worse clinical outcomes.

Written by:
Hsu CC, Paciorek AT, Cooperberg MR, Roach M 3rd, Hsu IC, Carroll PR.   Are you the author?
Department of Radiation Oncology, University of California at San Francisco.

Reference: BJU Int. 2015 Jan 20. Epub ahead of print.
doi: 10.1111/bju.13043


PubMed Abstract
PMID: 25600860

UroToday.com Prostate Cancer Section

E-Newsletters

Newsletter subscription

Free Daily and Weekly newsletters offered by content of interest

The fields of GU Oncology and Urology are rapidly advancing. Sign up today for articles, videos, conference highlights and abstracts from peer-review publications by disease and condition delivered to your inbox and read on the go.

Subscribe