Adjuvant or early salvage radiotherapy for the treatment of localised and locally advanced prostate cancer: a prospectively planned systematic review and meta-analysis of aggregate data

Abstract

around 65 years and most (78%) had a Gleason sum score of 7. All trials were assessed as having low risk of bias.Based on 270 EFS events, the meta-analysis showed no evidence that EFS was improved with ART compared to a policy of SRT (HR=0.95, 95% CI=0.75-1.21, p=0.70), with only a 1% change in 5-year EFS (89% vs. 88%). Results were consistent across trials (heterogeneity p=0.18; I 2 =42%). Although power is limited, we did not see any strong evidence of a difference in the treatment effect according to any of the patient or disease characteristics assessed. InterpretationThis collaborative, and prospectively-designed systematic review and meta-analysis suggests that ART does not improve EFS in men with localised or locally advanced prostate cancer. Until data on long-term outcomes are available, early salvage treatment would seem the preferable treatment policy as it offers the opportunity to spare many men from RT and its associated side-effects.

A novel imaging based Nomogram for predicting post-surgical biochemical recurrence and adverse pathology of prostate cancer from pre-operative bi-parametric MRI

“…This could allow for identifying men who are not candidates for active surveillance (AS), but rather candidates for more aggressive treatments. Additionally, since the benefit of adjuvant radiation therapy is subject to debate [35] , pre-operatively identifying patients with low risk of developing BCR after surgery could give clinicians more confidence in deferring additional treatments in these men. In this study, we developed a novel radiomic risk score, RadS, derived from computerized texture features from pre-surgical bi-parametric MRI that was shown to be independently prognostic of biochemical recurrence free survival (bRFS).…”

Management of Persistently Elevated Prostate-specific Antigen After Radical Prostatectomy: A Systematic Review of the Literature

“…No OS benefit was achieved (HR 0.69, p = 0.4) after a median follow-up of 9 yr. Moreover, adjuvant RT may lead to unnecessary toxicity, as highlighted in the recently published ARTISTIC analysis [33]. Thus, the CSS or OS benefit of immediate RT in men with persistently elevated PSA still remains debatable given the lack of dedicated RCT.…”

Management of prostate cancer radiotherapy during the COVID-19 pandemic: A necessary paradigm change

“…As a general rule, early salvage radiotherapy is a preferable option over adjuvant radiotherapy after radical prostatectomy. Such therapeutic strategy, which has been recently significantly sustained by the evidence coming from RAVES and RADICALS 38 , 39 , represents an even more valid approach in a pandemic scenario [39] .…”