scholarly journals Adjuvant vs. salvage radiation therapy in men with high-risk features after radical prostatectomy: Survey of North American genitourinary expert radiation oncologists

2018 ◽  
Vol 13 (5) ◽  
Author(s):  
Shearwood McClelland 3rd ◽  
Kiri A. Sandler ◽  
Catherine Degnin ◽  
Yiyi Chen ◽  
Timur Mitin
Keyword(s):  
Radiation Therapy ◽  
High Risk ◽  
Radical Prostatectomy ◽  
North American ◽  
Randomized Clinical Trials ◽  
Current View ◽  
Adjuvant Radiation ◽  
Exact Test ◽  
Salvage Radiation Therapy ◽  
Radiation Oncologists

Introduction: The management of patients with high-risk features after radical prostatectomy (RP) is controversial. Level 1 evidence demonstrates that adjuvant radiation therapy (RT) improves survival compared to no treatment; however, it may overtreat up to 30% of patients, as randomized clinical trials (RCTs) using salvage RT on observation arms failed to reveal a survival advantage of adjuvant RT. We, therefore, sought to determine the current view of adjuvant vs. salvage RT among North American genitourinary (GU) radiation oncology experts. Methods: A survey was distributed to 88 practicing North American GU physicians serving on decision-making committees of cooperative group research organizations. Questions pertained to opinions regarding adjuvant vs. salvage RT for this patient population. Treatment recommendations were correlated with practice patterns using Fisher’s exact test. Results: Forty-two of 88 radiation oncologists completed the survey; 23 (54.8%) recommended adjuvant RT and 19 (45.2%) recommended salvage RT. Recommendation of active surveillance for Gleason 3+4 disease was a significant predictor of salvage RT recommendation (p=0.034), and monthly patient volume approached significance for recommendation of adjuvant over salvage RT; those seeing <15 patients/month trended towards recommending adjuvant over salvage RT (p=0.062). No other demographic factors approached significance. Conclusions: There is dramatic polarization among North American GU experts regarding optimal management of patients with highrisk features after RP. Ongoing RCTs will determine whether adjuvant RT improves survival over salvage RT. Until then, the almost 50/50 division seen from this analysis should encourage practicing clinicians to discuss the ambiguity with their patients.

Adjuvant versus salvage radiation therapy in men with high risk features after radical prostatectomy: Survey of North American genitourinary expert radiation oncologists.

2018 ◽  
Vol 36 (15_suppl) ◽  
pp. e17078-e17078 ◽  
Author(s):  
Shearwood McClelland ◽  
Kiri A. Sandler ◽  
Catherine Degnin ◽  
Yiyi Chen ◽  
Timur Mitin
Keyword(s):  
Radiation Therapy ◽  
High Risk ◽  
Radical Prostatectomy ◽  
North American ◽  
Salvage Radiation Therapy ◽  
Radiation Oncologists

Redefining the role of adjuvant versus salvage radiation therapy for prostate cancer after radical prostatectomy for T3 disease and/or positive margins.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 367-367
Author(s):  
Barry W. Goy ◽  
In-Lu Amy Liu
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
High Risk ◽  
Radical Prostatectomy ◽  
Hormonal Therapy ◽  
Salvage Therapy ◽  
Low Risk ◽  
Adjuvant Radiation ◽  
Positive Margins ◽  
Salvage Radiation Therapy

367 Background: SWOG 8794 recommends adjuvant radiation therapy (ART) after radical prostatectomy (RP) for T3 and/or positive margins. Our purpose was to assess 12-year outcomes on 862 RP patients who had either T3 and/or positive margins who underwent surveillance, salvage radiation therapy (SRT), or hormonal therapy (HT), while categorizing these patients into very low risk (VLR), low risk (LR), high risk (HR), and ultra high risk (UHR) groups. Methods: From 2004 - 2007, 862 RP patients had adverse factors of extracapsular penetration (T3a), seminal vesicle invasion (T3b), positive margins, and/or detectable post-operative PSA. Management included surveillance (54.8%), SRT (36.8%), and HT (8.5%) as first salvage therapy, and 21.5% eventually received hormonal therapy. Twenty patients underwent ART, and were excluded from this analysis. We assessed prognostic factors using multivariable analysis, and 12-year estimates of freedom from biochemical failure (FFBF), freedom from salvage therapy (FFST), distant metastases-free survival (DMFS), prostate cancer-specific survival (PCSS), and overall survival (OS). VLR were those with Gleason Score (GS) of 6. LR were GS 3+4 with only T3a or positive margins, but an undetectable postoperative PSA <0.1. HR were T3b with GS 7-10, any GS 7-10 with T3a/b and positive margins, but an undetectable PSA. UHR were those with a detectable PSA with a GS 7-10. Results: Median follow-up was 12.1 years. Median age was 61.6 years. Median time to first salvage treatment for VLR, LR, HR, and UHR were 10.8, 11.1, 5.3, and 0.6 years, p<0.001. 12-year estimates of FFBF for VLR, LR, HR, and UHR were 60.2%, 52.9%, 28.4%, and 0%, p<0.0001. For FFST, 70.9%, 68.6%, 40.5%, and 0%, p<0.0001. For DMFS, 99.1%, 97.8%, 88.6%, and 63.6%, p<0.0001. For PCSS, 99.4%, 99.5%, 93.5%, and 78.9%, p<0.0001. For OS, 91.8%, 91.8%, 81.0%, and 69.9%, p<0.0001. Conclusions: Outcomes of T3 and/or positive margins using surveillance or SRT as initial management yields excellent outcomes for VLR and LR groups, in which ART should be avoided. For HR, ART can be considered reasonable, since FFBF is only 28.4%. For VHR, these patients may benefit from combined hormonal therapy and ART.

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

2021 ◽  
pp. JCO.20.03714
Author(s):  
Derya Tilki ◽  
Ming-Hui Chen ◽  
Jing Wu ◽  
Hartwig Huland ◽  
Markus Graefen ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Radical Prostatectomy ◽  
Causal Effect ◽  
Specific Antigen ◽  
Study Cohort ◽  
Adjuvant Radiation ◽  
Salvage Radiation Therapy ◽  
Risk Of Death ◽  
The Impact

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.

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

2016 ◽  
Vol 119 (5) ◽  
pp. 717-723 ◽  
Author(s):  
Derya Tilki ◽  
Felix Preisser ◽  
Pierre Tennstedt ◽  
Patrick Tober ◽  
Philipp Mandel ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Radical Prostatectomy ◽  
Oncological Outcome ◽  
Adjuvant Radiation ◽  
Adjuvant Radiation Therapy ◽  
Salvage Radiation Therapy

1059: Adjuvant Radiation Therapy Following Radical Prostatectomy for Adverse Pathology

2004 ◽  
Vol 171 (4S) ◽  
pp. 279-280
Author(s):  
Jonathan Rubenstein ◽  
Misop Han ◽  
Sheila A. Hawkins ◽  
William J. Catalona
Keyword(s):  
Radiation Therapy ◽  
Radical Prostatectomy ◽  
Adjuvant Radiation ◽  
Adjuvant Radiation Therapy

scholarly journals Prostate Cancer–Specific Mortality and Survival Outcomes for Salvage Radiation Therapy After Radical Prostatectomy

2016 ◽  
Vol 96 (2) ◽  
pp. S101 ◽  
Author(s):  
S. Agrawal ◽  
A.J. Stephenson ◽  
J. Michalski ◽  
J.A. Efstathiou ◽  
T.M. Pisansky ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Radical Prostatectomy ◽  
Survival Outcomes ◽  
Salvage Radiation Therapy ◽  
Specific Mortality ◽  
Cancer Specific Mortality
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