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Early radiotherapy after radical prostatectomy improves cancer‐specific survival only in patients with highly aggressive prostate cancer: Validation of recently released criteria
Author(s) -
Gandaglia Giorgio,
Karakiewicz Pierre I,
Briganti Alberto,
Trudeau Vincent,
Trinh QuocDien,
Kim Simon P,
Montorsi Francesco,
Nguyen Paul L,
Abdollah Firas,
Sun Maxine
Publication year - 2015
Publication title -
international journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.172
H-Index - 67
eISSN - 1442-2042
pISSN - 0919-8172
DOI - 10.1111/iju.12605
Subject(s) - medicine , prostatectomy , prostate cancer , radiation therapy , cancer , oncology , proportional hazards model , urology , biochemical recurrence , gynecology
Objectives To test the effect of radiotherapy administered within 6 months after radical prostatectomy on cancer‐specific mortality in prostate cancer patients after stratification according to a risk score. Methods Overall, 7616 patients with pT3 /4 N 0/1 prostate cancer treated with radical prostatectomy between 1995 and 2009 within the S urveillance E pidemiology and E nd R esults M edicare‐linked database were included in the study. Competing‐risks regression models were carried out to test the effect of early radiotherapy on cancer‐specific mortality in the entire cohort, and after stratifying patients according to the risk score based on the number and nature of adverse pathological characteristics ( G leason score 8–10; pT3b /4, lymph node invasion). Results The risk score was associated with increasing 5‐ and 10‐year cancer‐specific mortality rates ( P < 0.001). When considering only patients with a risk score ≥ 2, 5‐ and 10‐year cancer‐specific mortality rates were significantly lower for individuals undergoing early radiotherapy compared with their counterparts not receiving early radiotherapy (2.9 and 6.9 vs 5.7 and 16.2%, respectively; P = 0.002). The corresponding number required to treat to prevent one death from prostate cancer at 10‐year follow up was 10. Early radiotherapy was not associated with lower cancer‐specific mortality rates overall and in patients with a risk score <2. This was confirmed in multivariable analyses, where early radiotherapy decreased the risk of cancer‐specific mortality only in patients with a risk score ≥ 2 ( P ≤ 0.02). Conclusions The presence of two or more of the following pathological features might be used to identify patients who benefit from early radiotherapy: G leason score 8–10, pT3b /4 and lymph node invasion.