Adjuvant Radiation Therapy After Radical Prostatectomy Decreases All-Cause Mortality

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In this study of 26,118 men with adverse pathology, the authors investigated the impact of adjuvant versus early salvage radiation therapy following radical prostatectomy. After a median of 8.16 years of follow-up, 8.06% of men had died, including 25.62% from prostate cancer. Adjuvant versus early salvage radiation therapy was associated with a significantly lower risk of all-cause mortality when men with pN1 disease were excluded or included.

These findings suggest the consideration of adjuvant radiation therapy for this population.

Advanced Prostate Cancer

Written by Oliver Sartor MD

Abstract

This abstract is available on the publisher's site.

PURPOSE

Adjuvant compared with early salvage radiation therapy (sRT) following radical prostatectomy (RP) has not been shown to reduce progression-free survival in randomized controlled trials. However, these trials might have missed a benefit in men with adverse pathology at RP given that these men were under-represented and immortal time bias might have been present; herein, we investigate this possibility.

METHODS

We evaluated the impact of adjuvant versus early sRT on all-cause mortality (ACM) risk in men with adverse pathology defined as positive pelvic lymph nodes (pN1) or pGleason score 8-10 prostate cancer (PC) and disease extending beyond the prostate (pT3/4). We used a treatment propensity score to minimize potential treatment selection bias when estimating the causal effect of adjuvant versus early sRT on ACM risk and a sensitivity analysis to assess the impact that varying definitions of adverse pathology had on ACM risk adjusting for age at RP, PC prognostic factors, site, and the time-dependent use of post-RP androgen deprivation therapy.

RESULTS

After a median follow-up (interquartile range) of 8.16 (6.00-12.10) years, of the 26,118 men in the study cohort, 2,104 (8.06%) died, of which 539 (25.62%) were from PC. After excluding men with a persistent prostate-specific antigen, adjuvant compared with early sRT was associated with a significantly lower ACM risk among men with adverse pathology at RP when men with pN1 PC were excluded (0.33 [0.13-0.85]; P = .02) or included (0.66 [0.44-0.99]; P = .04).

CONCLUSION

Adjuvant radiation therapy should be considered in men with pN1 or pGleason score 8 to 10 and pT3/4 PC given the possibility that a significant reduction in ACM risk exists.

Citation:

Journal of Clinical Oncology

Adjuvant Versus Early Salvage Radiation Therapy for Men at High Risk for Recurrence Following Radical Prostatectomy for Prostate Cancer and the Risk of Death

J. Clin. Oncol 2021 Jun 04;[EPub Ahead of Print], D Tilki, MH Chen, J Wu, H Huland, M Graefen, T Wiegel, D Böhmer, O Mohamad, JE Cowan, FY Feng, PR Carroll, BJ Trock, AW Partin, AV D'Amico

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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