Abstract
OBJECTIVE
To determine trends and predictors of adjuvant therapy in patients with adverse features
at radical prostatectomy (RP), and to investigate the associations of adjuvant therapy
and adverse feature type with survival.
METHODS
From the Cancer of the Prostate Strategic Urologic Research Endeavor registry (1990-2017),
2209 men with adverse features (pT3N0M0 disease and/or positive surgical margins),
and 108 men with positive lymph nodes (pN1) at RP were identified. Temporal trends
were evaluated, and predictors of adjuvant therapy were assessed with multivariate
logistic regression. Kaplan-Meier analysis and competing risks regression were used
to test cumulative incidence and risk of all-cause and prostate cancer-specific mortality.
RESULTS
Of 2209 men with adverse features and pN0 disease, 89 (4.0%), 82 (3.7%), and 30 (1.4%)
received adjuvant external beam radiation therapy (ERBT) alone, androgen deprivation
therapy (ADT) alone, or combined EBRT and ADT, respectively. Of 108 men with pN1 disease,
54 (50%) received ADT with or without EBRT. Adjuvant treatment for patients with adverse
features decreased from 13.3% (1990-1994) to 6% or less (2005-2017, Ptrend <.001). Patients with margin positive pT3a (odds ratio 4.13; 95% confidence interval
2.21-7.73; P<.01) and margin positive pT3b disease (odds ratio 7.09; 95% confidence interval 3.66-1.73;
P<.01) had greater odds of receiving adjuvant therapy compared to patients with margin
negative pT3a disease. Adverse feature type was associated with prostate cancer-specific
mortality in univariate analysis (log-rank P <.01), but not in competing risks regression (P= .06).
CONCLUSION
Adjuvant therapy declined for men with adverse features at RP. Providers do not treat
all adverse feature types the same way, despite broad treatment recommendations in
guidelines.
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Article info
Publication history
Published online: May 28, 2019
Accepted:
May 3,
2019
Received:
February 1,
2019
Footnotes
Conflicts of Interest: The authors declare that there are no conflicts of interest.
Funding Support: This work was supported in part by the US Department of Defense Prostate Cancer Research Program (W81XWH-13-2-0074).
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
