Objective
To evaluate if adjuvant radiation therapy (ART) is associated with improved long-term
oncologic outcomes for pT2N0R1 prostate cancer (PCa).
Methods
Men with pT2N0 PCa and a single positive surgical margin following radical prostatectomy
and pelvic lymphadenectomy were identified (1987-1996). Men who received ART were
matched 1:1 to men who did not receive ART based on age, year of surgery, Gleason
score, preoperative prostate-specific antigen, site of positive surgical margin, and
DNA ploidy. Biochemical recurrence (BCR), local recurrence, distant metastasis, and
overall survival (OS) were compared between groups in time-to-event analyses.
Results
The cohort included 152 men (76 per group) with a median follow-up of 20 years (interquartile
range 19,22). ART was associated with a lower cumulative incidence of BCR (25% vs
52%; P <.001) and local recurrence (3% vs 12%; P = .03), but no significant differences in cumulative incidence of distant metastasis
(10% vs 7%; P = .44) or in probability of OS (56% vs 68%; P = .08) at 20 years. In competing risks models, receipt of ART was associated with
reduced risks of BCR (hazard ratio [HR] = 0.40; 95% confidence interval [CI] 0.23-0.70;
P <.001) and local recurrence (HR = 0.21; 95% CI .05-0.98; P = .05), but not distant metastasis (HR = 1.56; 95% CI 0.51-4.75; P = .43). In the Cox model, ART was not associated with improved OS (HR = 1.56; 95%
CI 0.94-2.57; P = .08).
Conclusion
ART was associated with reduced risks of BCR and local recurrence for men with pT2N0R1
PCa. However, ART was not significantly associated with metastasis-free or OS benefits,
as recurrences in these patients generally followed an indolent trajectory with 20
years of median follow-up.
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Article info
Publication history
Published online: August 17, 2017
Accepted:
June 6,
2017
Received:
February 20,
2017
Footnotes
Financial Disclosure: The authors declare that they have no relevant financial interests.
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
