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- Title
Postoperative radiation therapy for patients at high-risk of recurrence after radical prostatectomy: does timing matter?
- Authors
Hsu, Charles C.; Paciorek, Alan T.; Cooperberg, Matthew R.; Roach, Mack; Hsu, I ‐ Chow J.; Carroll, Peter R.
- Abstract
Objective To evaluate among radical prostatectomy ( RP) patients at high-risk of recurrence whether the timing of postoperative radiation therapy ( RT) (adjuvant, early salvage with detectable post- RP prostate-specific antigen [ PSA], or 'late' salvage with a PSA level of >1.0 ng/mL) is significantly associated with overall survival ( OS), prostate-cancer specific survival or metastasis-free survival, in a longitudinal cohort. Patients and Methods Of 6 176 RP patients in the Cancer of the Prostate Strategic Urologic Research Endeavor (Ca PSURE), 305 patients with high-risk pathological features (margin positivity, Gleason score 8-10, or pT3-4) who underwent postoperative RT were examined, either in the adjuvant (≤6 months after RP with undetectable PSA levels, 76 patients) or salvage setting (>6 months after RP or pre- RT PSA level of >0.1 ng/mL, 229 patients). Early ( PSA level of ≤1.0 ng/mL, 180 patients) or late salvage RT ( PSA level >1.0 ng/mL, 49 patients) was based on post- RP, pre- RT PSA level. Multivariable Cox regression examined associations with all-cause mortality and prostate cancer-specific mortality and/or metastases (PCSMM). Results After a median of 74 months after RP, 65 men had died (with 37 events of PCSMM). Adjuvant and salvage RT patients had comparable high-risk features. Compared with adjuvant, salvage RT (early or late) had an increased association with all-cause mortality (hazard ratio [ HR] 2.7, P = 0.018) and with PCSMM ( HR 4.0, P = 0.015). PCSMM-free survival differed by further stratification of timing, with 10-year estimates of 88%, 84%, and 71% for adjuvant, early salvage, and late salvage RT, respectively ( P = 0.026). For PCSMM-free survival and OS, compared with 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 RT with PSA levels of <1.0 ng/mL may have comparable metastasis-free survival and OS compared with adjuvant RT; however, late salvage RT with a PSA level of >1.0 ng/ mL is associated with worse clinical outcomes.
- Subjects
RADIOTHERAPY; PROSTATECTOMY; SALVAGE therapy; PROSTATE cancer; METASTASIS
- Publication
BJU International, 2015, Vol 116, Issue 5, p713
- ISSN
1464-4096
- Publication type
Article
- DOI
10.1111/bju.13043