PURPOSE: Level 1 evidence supports immediate radiation use in post-prostatectomy patients with adverse pathologic features, while analogous evidence for delayed radiation is lacking.
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We sought to evaluate immediate and delayed radiation utilization and to identify factors affecting their use.
MATERIALS AND METHODS: Using the National Cancer Database, we identified 57,448 men diagnosed with pT3 disease and/or positive margins from 2004-2009. Post-operative radiation utilization through 2011 was analyzed by time trends and multivariate analysis.
RESULTS: 4,316 (7.5%) men received immediate radiation; 1,637 (2.8%) received delayed radiation; and 51,495 (90%) were observed. Immediate and delayed radiation usage remained relatively stable except for a small but significant decline in immediate radiation in 2008. This decline was associated with a relative increase in dRT. Compared to 2004, men diagnosed in 2007-2009 had 1.3-1.5x higher odds of delayed radiation than immediate radiation (p< 0.01). The strongest predictors of immediate radiation were margin status, T stage, N stage, Gleason score, and patient age. Men with positive margins, seminal vesicle invasion, nodal disease, or Gleason score ≥8 and younger men had 2.3-6.0x greater odds of receiving immediate radiation than observation (p< 0.01). Men with positive margins, seminal vesicle invasion, or nodal metastases were also more likely to receive immediate rather than delayed radiation (p< 0.01).
CONCLUSIONS: Post-prostatecomy radiation is used sparingly. Immediate radiation rates remain low but do not appear to be influenced substantially by delayed radiation usage. Consistent with the evidence, patients at high-risk for recurrence are more likely to undergo immediate radiation rather than observation or delayed radiation.
Maurice MJ, Zhu H, Abouassaly R. Are you the author?
Urology Institute, University Hospitals Case Medical Center, Cleveland, OH; Louis Stokes Cleveland VA Medical Center, Cleveland, OH; Glickman Urologic and Kidney Institute, Cleveland Clinic South Pointe Hospital, Cleveland, OH.
Reference: J Urol. 2015 Apr 6. pii: S0022-5347(15)03697-6.