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Postoperative radiation therapy for patients at high‐risk of recurrence after radical prostatectomy: does timing matter?
Author(s) -
Hsu Charles C.,
Paciorek Alan T.,
Cooperberg Matthew R.,
Roach Mack,
Hsu IChow J.,
Carroll Peter R.
Publication year - 2015
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.13043
Subject(s) - medicine , prostatectomy , prostate cancer , biochemical recurrence , hazard ratio , salvage therapy , prostate specific antigen , proportional hazards model , urology , cohort , radiation therapy , surgery , adjuvant therapy , oncology , cancer , chemotherapy , confidence interval
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 pT 3–4) 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.