A Multi-Institutional Matched-Control Analysis of Adjuvant and Salvage Postoperative Radiation Therapy for pT3-4N0 Prostate Cancer

Received 16 January 2008; accepted 13 May 2008. published online 30 July 2008.

Refers to article:

Editorial Comment
Mack Roach
Urology
December 2008 (Vol. 72, Issue 6, Pages 1302-1303)
Full Text | Full-Text PDF (107 KB)

Reply
Edouard J. Trabulsi, Richard K. Valicenti
Urology
December 2008 (Vol. 72, Issue 6, Page 1303)
Full Text | Full-Text PDF (91 KB)

Objectives

It is unclear whether postoperative salvage radiation therapy (SRT) and early adjuvant radiotherapy (ART) after radical prostatectomy lead to equivalent long-term tumor control. We studied a group of patients undergoing ART by comparing them with a matched control group undergoing SRT after biochemical failure.

Methods

Using a multi-institutional database of 2299 patients, 449 patients with pT3-4N0 disease were eligible for inclusion, including 211 patients receiving ART and 238 patients receiving SRT. Patients were matched in a 1:1 ratio according to preoperative prostate-specific antigen Gleason score, seminal vesicle invasion, surgical margin status, and follow-up from date of surgery.

Results

A total of 192 patients were matched (96:96). The median follow-up was 94 months from surgery and 73 months from RT completion. There was a significant reduction in biochemical failure with ART compared with SRT. The 5-year freedom from biochemical failure (FFBF) from surgery was 75% after ART, compared with 66% for SRT (hazard ratio [HR] = 1.6, P = .049). The 5-year FFBF from the end of RT was 73% after ART, compared with 50% after SRT (HR = 2.3, log rank [LR] P = .0007). From the end of RT, SRT and Gleason score ≥8 were independent predictors of diminished FFBF. From the date of surgery, Gleason score ≥8 was a significant predictor of FFBF.

Conclusions

Early ART for pT3-4N0 prostate cancer significantly reduces the risk of long-term biochemical progression after radical prostatectomy compared with SRT. Gleason score ≥8 was the only factor on multivariate analysis associated with metastasic progression.

a Department of Urology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania

b Department of Radiation Oncology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania

c Department of Biostatistics, Temple University, Philadelphia, Pennsylvania

d Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania

e Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota

f Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan

g Department of Radiation Oncology, Wayne State University School of Medicine, Detroit, Michigan

h Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan

i Department of Radiation Oncology, MD, Anderson Cancer Center, Houston, Texas

j Department of Urology, Baylor College of Medicine, Houston, Texas

k Department of Urology, University of Texas-Southwestern Medical Center, Dallas, Texas

l Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada

m Department of Radiation Oncology, Washington University, St. Louis, Missouri

n Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York

o Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, New York

p Department of Radiation Oncology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio

q Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio

r Department of Urology, University of Washington School of Medicine, Seattle, Washington

s Department of Radiation Oncology, Duke University School of Medicine, Durham, North Carolina

t Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida

u Department of Radiation Oncology, Johns Hopkins University, Baltimore, Maryland

Reprint requests: Richard K. Valicenti, MD, Department of Radiation Oncology, Thomas Jefferson University, 111 S. 11th St, Philadelphia, PA 19107

PII: S0090-4295(08)00770-X

doi:10.1016/j.urology.2008.05.057

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