Adjuvant Radiotherapy Found Superior to Early-Salvage RT in Prostate Cancer

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Fears of recurrence following treatment have led to decreased implementation of postoperative ART.
Fears of recurrence following treatment have led to decreased implementation of postoperative ART.

Adjuvant radiotherapy (ART) may lead to improved clinical outcomes among patients with prostate cancer postprostatectomy compared with early-salvage radiotherapy (ESRT), according to a study published in JAMA Oncology.

Current guidelines recommend postoperative ART for high-risk patients with prostate cancer, but fears of recurrence after treatment have led to decreased implementation of the therapy. Retrospective data have shown that ESRT delivery when prostate-specific antigen (PSA) levels become detectable may lead to effective long-term disease control in this patient population.


For this propensity score-matched cohort study, researchers assessed the outcomes of 1566 patients with prostate cancer who underwent ART or ESRT after prostatectomy. The researchers defined ART as radiation therapy administered to patients with undetectable PSA levels, and ESRT as radiation therapy delivered to patients with PSA levels between 0.1 and 0.5 ng/mL. Patients were ineligible for the study if they had nodal involvement or received androgen deprivation therapy prior to surgery.

Of the study patients, 1195 patient underwent ESRT and 371 patients underwent ART. The median follow-up was similar between both study arms (73.3 months and 65.8 months, respectively).


After propensity-score matching, results showed that patients who received ART experienced improvements in freedom from biochemical failure, freedom from distant metastases, and overall survival compared with ESRT.

The authors concluded that “these findings suggest that a greater proportion of patients with prostate cancer who have adverse pathological features may benefit from postprostatectomy ART rather than surveillance followed by ESRT,” but also noted that these findings require further prospective validation.

Reference

Hwang WL, Tendulkar RD, Niemierko A, et al. Comparison between adjuvant and early-salvage postprostatectomy radiotherapy for prostate cancer with adverse pathological features [published online January 25, 2018]. JAMA Oncol. doi: 10.1001/jamaoncol.2017.5230
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