More men should have radiation therapy after radical prostatectomy

Radiation therapy immediately following a radical prostatectomy is a cost-effective treatment for men with prostate cancer, but urologists are less likely than radiation oncologists to recommend this adjuvant treatment.

Concerns regarding associated toxicities, risk of overtreatment, and costs have called into question the appropriateness of adjuvant radiation therapy after prostate removal, despite data supporting overall survival benefits. However, a new decision analysis published online by the Annals of Oncology found that over a 10-year time horizon, adjuvant radiation therapy appears to be cost-effective compared with observation/acting on elevated levels of prostate-specific antigen (PSA)—even when taking toxicity, overtreatment, and other negative factors into consideration.

The new finding “substantiates the benefit of adjuvant radiation therapy,” commented Timothy Showalter, MD, assistant professor of radiation oncology at Thomas Jefferson University in Philadelphia, Pennsylvania, and associate research member of the Kimmel Cancer Center at Jefferson, in a statement describing his group's findings.        

Showalter also worked with several of the same co-investigators on another study, this one published online by the International Journal of Radiation Oncology, Biology, Physics, which indicated that urologists are less likely than radiation oncologists to recommend radiation therapy immediately after a radical prostatectomy. A survey of 218 radiation oncologists and 92 urologists revealed that urologists are also less likely to believe that adjuvant radiation therapy improves overall survival, and perceive higher rates of radiation-related toxicities than radiation oncologists.

The researchers pointed out that use of adjuvant radiation therapy has not increased since the publication of randomized trials supporting the therapy, suggesting that clinicians have not embraced it.

“Despite being shown to be effective, less than 20% of qualifying patients receive it,” affirmed Showalter in the accompanying statement. “Although not all patients will benefit from adjuvant radiation therapy, the level of utilization is lower than expected based on the positive, published results of randomized clinical trials. Studies like this one [the decision analysis] are an important step toward establishing the value of this treatment and suggest that adjuvant radiation therapy should have a role in the treatment of selected patients.”

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