Do urologists and radiation oncologists agree on adjuvant radiation therapy for prostate cancer? A web-based patterns-of-care survey.

2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 76-76
Author(s):  
T. N. Showalter ◽  
K. A. Teti ◽  
K. A. Foley ◽  
S. W. Keith ◽  
E. J. Trabulsi ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Gleason Score ◽  
Positive Surgical Margin ◽  
Adjuvant Radiation ◽  
Biochemical Control ◽  
Web Based ◽  
Adjuvant Radiation Therapy ◽  
Radiation Oncologists ◽  
Pathologic Features

76 Background: Three randomized trials support adjuvant radiation therapy (ART) over observation after radical prostatectomy (RP) for prostate cancer (PC) patients with adverse pathologic features (APFs), but many clinicians instead favor early salvage RT (SRT) for a rising PSA. We conducted a web-based survey of U.S. radiation oncologists (RO) and urologists (U) regarding ART and SRT. Methods: We designed a web-based survey to evaluate beliefs about post-RP RT and treatment policies. Survey invitations were e-mailed to SUO members and a list of 926 RO ASTRO members with an interest in PC. One email was sent to limit message burden. Only those responses at least 50% complete were included in the analysis. Differences in ART recommendation rates were evaluated by chi square test. Results: Responses were received from 231 RO and 101 U, resulting in 302 analyzable responses (88 U, 214 RO). 79% of U and 32% of RO respondents were academic physicians. ART was recommended based on APF alone (78% RO, 44% U), based on APF plus Gleason score or PSA (14% RO, 35% U), only for detectable PSA (7% RO, 14% U), or never (2% RO, 7% U). When asked the effect of ART on outcomes, most respondents replied “improves survival” (71% RO, 63% U) or “improves biochemical control but not survival” (29% RO, 30% U), but 9% of U replied “delays PSA recurrence, but no durable benefit” or “no improvement in any outcomes” (versus 0% RO). A recommendation for ART based on APFs alone was made for: seminal vesicle invasion (SVI) (76% RO, 59% U; p=0.003), extracapsular extension (ECE) (70% RO, 32% U; p<0.001), positive surgical margin (PSM) (91% RO, 48% U; p<0.002). For patients with Gleason score 8-10 PC, ART was recommended for: SVI (75% RO, 56% U; p=0.001), ECE (73% RO, 45% U; p<0.001), PSM (93% RO, 74% U; p<0.001). Reported PSA threshold for SRT was: any detectable (36% RO, 23% U), 0.2-0.3 (50% RO, 36% U), 0.4-0.5 (9% RO, 30% U), 0.6-0.8 (3% RO, 10% U) ng/mL, or higher (1% RO, 1% U). Conclusions: Despite similar rates of belief that ART improves survival or biochemical control, U were less likely than RO to recommend ART based solely on APFs after RP. Upcoming results of clinical trials of ART versus SRT may provide consensus for decisions in this setting. No significant financial relationships to disclose.

BENEFIT OF ADJUVANT RADIATION THERAPY FOR LOCALIZED PROSTATE CANCER WITH A POSITIVE SURGICAL MARGIN

2000 ◽  
pp. 1178-1182 ◽  
Author(s):  
BRADLEY C. LEIBOVICH ◽  
DONALD E. ENGEN ◽  
DAVID E. PATTERSON ◽  
THOMAS M. PISANSKY ◽  
ERIK E. ALEXANDER ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Surgical Margin ◽  
Localized Prostate Cancer ◽  
Positive Surgical Margin ◽  
Adjuvant Radiation ◽  
Adjuvant Radiation Therapy

Surgical management versus combination radiotherapy in Gleason score 9-10 prostate cancer.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 135-135 ◽  
Author(s):  
Edward Christopher Dee ◽  
Martin T. King ◽  
Santino Butler ◽  
Zizi Yu ◽  
Sybil Sha ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Surgical Management ◽  
Gleason Score ◽  
Patient Selection ◽  
External Beam Radiation ◽  
Patient Specific ◽  
Adjuvant Radiation ◽  
Beam Radiation ◽  
Pathologic Features

135 Background: For men with Gleason score 9-10 prostate cancer, studies have demonstrated conflicting results on the outcomes from combination radiation therapy (ComboRT) with external beam radiation therapy plus brachytherapy boost versus radical prostatectomy (RP), with or without adjuvant radiation therapy (ART). Differences in patient selection and management may explain some of the disparate outcomes of prior reports. Methods: The Surveillance, Epidemiology, and End Results database identified 10,396 men managed with ComboRT versus RP (+/-ART). Competing-risks regression analysis with treatment propensity adjustment defined hazard ratios (aHR) for prostate cancer-specific mortality (PCSM), controlling for patient-specific demographic factors. To explore the possible effect of patient selection, analyses were conducted before and after excluding men from analysis if they had evidence-based indications for ART (adverse pathology, i.e. pT3-T4 or positive margins) but did not receive it. Results: Median age was 64 years; median follow-up was 69 months. Five-year PCSM was similar between patients treated with RP (with or without ART, regardless of pathologic features, N=8,934) and ComboRT (N=1,462) (6.9% vs 8.1%, aHR=0.94, 95% confidence interval [CI] 0.78–1.13, P=0.51). After excluding RP-treated men with adverse pathology who did not receive ART (N=4,527 excluded), patients treated with RP+/-ART (N=4,407) had improved 5-year PCSM compared with those treated with ComboRT (5.3% vs 8.1%, aHR=0.74, 95% CI 0.60–0.91, P=0.004). Conclusions: For Gleason 9-10 prostate cancer, ComboRT was associated with similar PCSM compared to RP, but risk-tailored surgical management may be associated with superior PCSM.

BENEFIT OF ADJUVANT RADIATION THERAPY FOR LOCALIZED PROSTATE CANCER WITH A POSITIVE SURGICAL MARGIN

2000 ◽  
Vol 163 (4) ◽  
pp. 1178-1182 ◽  
Author(s):  
BRADLEY C. LEIBOVICH ◽  
DONALD E. ENGEN ◽  
DAVID E. PATTERSON ◽  
THOMAS M. PISANSKY ◽  
ERIK E. ALEXANDER ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Surgical Margin ◽  
Localized Prostate Cancer ◽  
Positive Surgical Margin ◽  
Adjuvant Radiation ◽  
Adjuvant Radiation Therapy

A population-based study of factors associated with post-prostatectomy radiation therapy utilization.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 182-182
Author(s):  
Matthew J. Maurice ◽  
Hui Zhu ◽  
Robert Abouassaly
Keyword(s):  
Radiation Therapy ◽  
Gleason Score ◽  
Strong Predictor ◽  
Teaching Hospitals ◽  
Time Range ◽  
Adjuvant Radiation ◽  
Cancer Society ◽  
Positive Margins ◽  
Pathologic Features ◽  
To Receive

182 Background: Based on level one evidence, adjuvant radiation therapy (aRT) improves cancer control in post-prostatectomy patients with adverse pathologic features. We sought to evaluate its utilization and to identify factors affecting of its use. Methods: Using the National Cancer Database, a joint project of the Commission on Cancer of the American College of Surgeons and the American Cancer Society, we identified men diagnosed with prostate cancer between 2004 and 2011 who were found to have pT3 disease or pT2 disease with positive margins following prostatectomy. We defined aRT as radiation to the prostate and/or pelvis 6 months or less after prostatectomy. We then used univariate and multivariate logistic regression models to assess potential patient and provider predictors of aRT use. Results: We evaluated 103,092 men who had either pT3 disease (81%) or pT2 with positive margins (19%). Of these, we identified 10,043 men (9.7%) who received aRT. Since 2004, there has been a steady decline in aRT usage with time (range, 11.5% to 7.8%). Compared to 2004, patients diagnosed in 2011 were significantly less likely to receive aRT (odds ratio [OR] 0.78, confidence interval [CI] 0.71-0.85, p<0.0001). Higher Gleason score and T stage were strongly associated with positive aRT utilization (p<0.0001), while increasing age was associated with decreased use (p<0.0001). Another strong predictor of aRT uptake was hospital type. Compared to patients treated at community hospitals, patients treated at comprehensive cancer centers or teaching hospitals were significantly less likely to receive aRT (OR 0.63, 0.58-0.68, p<0.0001 or OR 0.42, CI 0.39-0.46, p<0.0001, respectively). Charlson score and hospital location were significantly but weakly associated with aRT. Other demographic variables were not predictive of aRT. Conclusions: Post-prostatectomy aRT use is declining despite clear proof of its benefit. Consistent with the evidence, patients with risk factors for biochemical relapse (i.e. high Gleason score or T3 disease) and younger patients, who are more likely to benefit, are receiving aRT. Surprisingly, aRT use is lower at teaching hospitals, which may reflect higher usage of salvage radiation.

Sign in / Sign up

Export Citation Format

Share Document