Adjuvant radiation therapy is associated with better oncological outcome compared to salvage radiation therapy in patients with pN1 prostate cancer treated with radical prostatectomy

To analyze the comparative effectiveness of no treatment or salvage radiation therapy at biochemical recurrence (NT/sRT) versus adjuvant radiation therapy (aRT) in LN positive patients after radical prostatectomy (RP).

A total of 773 patients with LN positive prostate cancer (PCa) at RP with or without additional radiation treatment from 2005 to 2013 were retrospectively analyzed. Cox regressions addressed factors influencing biochemical recurrence (BCR) and metastasis-free survival (MFS). Propensity score-matched analyses were performed.

Median follow-up for the entire patient group was 33.8 months. Four-year BCR-free and metastasis-free survival rates were 43.3% and 86.6% for all patients, respectively. In multivariate analysis, NT/sRT (n=505) was an independent risk factor for BCR and metastasis compared to patients with aRT (n=213). The superiority of aRT was confirmed after propensity score-matching. Four-year metastasis-free survival in the matched cohort was 82.5% versus 91.8% for the NT/sRT and aRT groups, respectively (p=0.02). Early sRT (pre-RT PSA ≤0.5 ng/ml) compared to sRT at PSA >0.5 ng/ml was significantly associated with decreased risk of metastasis.

LN positive patients who received aRT had a significantly better oncological outcome compared to patients with NT/sRT independent of tumor characteristics. Patients with early sRT showed higher rates of response and better metastasis-free survival than patients with pre-RT PSA >0.5 ng/ml. This article is protected by copyright. All rights reserved.

BJU international. 2016 Oct 15 [Epub ahead of print]

Derya Tilki, Felix Preisser, Pierre Tennstedt, Patrick Tober, Philipp Mandel, Thorsten Schlomm, Thomas Steuber, Hartwig Huland, Schwarz Rudolf, Cordula Petersen, Markus Graefen, Sascha Ahyai

Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany., Department of Radiation Oncology, University Hospital Hamburg-Eppendorf, Hamburg, Germany., Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany. .

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