Benefit of Adjuvant Radiation Therapy for Localized Prostate Cancer With a Positive Surgical Margin

Leibovich, Bradley C.; Engen, Donald E.; Patterson, David E.; Pisansky, Thomas M.; Alexander, Erik E.; Blute, Michael L.; Bergstralh, Erik J.; Zincke, Horst

doi:10.1016/s0022-5347(05)67717-8

Cited by 101 publications

(21 citation statements)

References 33 publications

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“…Some authors have claimed that in patients with unfavorable prognostic factors it should be performed immediately after surgery [14, 26, 27, 30], while others have advised to wait until the PSA is increased or until biopsy confirms local recurrence [31, 32]. However, external beam irradiation has been widely used as a postoperative method of treatment.…”

Section: Discussionmentioning

confidence: 99%

Review The role of postoperative radiotherapy in prostate cancer patients

Zarzycka¹,

Ziółkowska²,

Wiśniewski³

et al. 2013

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Aim of the studyThe aim of the study was to evaluate the effectiveness of postoperative radiotherapy in prostate cancer patients with unfavorable prognostic factors.Material and methodsIn the years 2002–2008, 121 consecutive prostate cancer patients underwent radical prostatectomy and postoperative radiotherapy. The median dose was 64 Gy (range: 60–72 Gy). Biochemical and clinical progression-free survival were estimated. Univariate and multivariate analyses were used to analyze clinicopathological variables associated with treatment failure.ResultsThe median follow-up was 27 months. Three-year bPFS was 72%. On univariate analysis it was influenced by: extracapsular tumor extension (60% vs. 75%, p = 0.0232), seminal vesicles invasion (52% vs. 85%, p = 0.00041), Gleason score ≥ 7 (65% vs. 86%, p = 0.044) and the use of hormonal therapy (50% vs. 80%, p = 0.0058). On multivariate analysis bPFS was associated with: TNM stage (HR = 3.19), postoperative hormonal therapy (HR = 2.6), total irradiation dose (HR = 0.82) and the maximum pretreatment level of prostate-specific antigen (PSA) (HR = 0.95). Three-year cPFS was 84%. On univariate analysis it was influenced by: preoperative PSA level > 10 ng/ml (75% vs. 90%, p = 0.04), vascular-nerve bundles involvement (63% vs. 88%, p = 0.0031), adjacent organs infiltration (50% vs. 85%, p = 0.018) and the use of postoperative hormonal therapy (62% vs. 90%, p = 0.02). On multivariate analysis cPFS was associated with: TNM stage (HR = 2.68), postoperative hormonal therapy (HR = 3.61) and total irradiation dose (HR = 0.78).ConclusionsPostoperative radiotherapy in patients with unfavorable prognostic factors provides good biochemical and local control. Total irradiation dose and postoperative hormonal therapy are important treatment factors influencing prognosis.

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Section: Discussionmentioning

confidence: 99%

Review The role of postoperative radiotherapy in prostate cancer patients

Zarzycka¹,

Ziółkowska²,

Wiśniewski³

et al. 2013

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“…762,768,771 Traditionally, EPE, SVI, or a positive surgical margin are the factors on which a recommendation for adjuvant RT is made. [774][775][776][777][778][779][780] It is generally acknowledged that RT improves local tumor control compared to prostatectomy alone, 774,776,778,779 which is reported in ~99% and ~92% of patients with adverse risk factors at 5 and 10 years after RT, Analysis of metastasis-free survival according to various patient subsets provided no evidence that any particular type of patient should not receive RT. 761,762,768 There is an abundant literature of adjuvant RT observational series, and Table 53-15 summarizes outcomes from selected reports.…”

Section: Adjuvant Radiotherapymentioning

confidence: 99%

“…[774][775][776][777][778][779][780] The 5-year and 10-year local control after RP alone is ~85% and ~61%. [774][775][776][777][778][779][780] The 5-year and 10-year local control after RP alone is ~85% and ~61%.…”

Section: Adjuvant Radiotherapymentioning

confidence: 99%

“…[774][775][776][777][778][779][780] The 5-year and 10-year local control after RP alone is ~85% and ~61%. 775,776,780 Nonetheless, an estimated one quarter of patients with biochemical relapse only after adjuvant RT has persistent cancer in the prostatic fossa, 782 and this suggests that improved target definition, localization, or dose escalation may improve outcomes. 775,776,780 Nonetheless, an estimated one quarter of patients with biochemical relapse only after adjuvant RT has persistent cancer in the prostatic fossa, 782 and this suggests that improved target definition, localization, or dose escalation may improve outcomes.…”

Section: Adjuvant Radiotherapymentioning

confidence: 99%

“…Pelvic nodal RT may be used in the node-positive setting, 1011 but recent series [1012][1013][1014][1015] and clinical trials 488,996,1016 otherwise defined the CTV as the prostatic fossa, and this is the current standard. CT simulation in supine position at ≤ 0.3-cm acquisition spacing with a protocol to assure the bladder is comfortably full and bowels are evacuated is recommended.…”

Section: Treatment Techniquementioning

confidence: 99%

See 2 more Smart Citations

Prostate Cancer

Michalski¹,

Pisansky²,

Lawton³

et al. 2016

Clinical Radiation Oncology

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High‐resolution MRI of excised human prostate specimens acquired with 9.4T in detection and identification of cancers: Validation of a technique

Fan

Haney

Agrawal

et al. 2011

Magnetic Resonance Imaging

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Purpose: To evaluate feasibility of high-resolution, highfield ex vivo prostate magnetic resonance imaging (MRI) as an aid to guide pathologists' examination and develop in vivo MRI methods. Materials and Methods:Unfixed excised prostatectomy specimens (n ¼ 9) were obtained and imaged immediately after radical prostatectomy under an Institutional Review Board-approved protocol. High-resolution T2-weighted (T2W) MRI of specimens were acquired with a Bruker 9.4 T scanner to correlate with whole-mount histology. Additionally, T2 and apparent diffusion coefficient (ADC) maps were generated.Results: By visual inspection of the nine prostate specimens imaged, high-resolution T2W MRI showed improved anatomical detail compared to published low-resolution images acquired at 4 T as published by other investigators. Benign prostatic hyperplasia, adenocarcinomas, curvilinear duct architecture distortion due to adenocarcinomas, and normal radial duct distribution were readily identified. T2 was %10 msec longer (P < 0.03) and the ADC was %1.4 times larger (P < 0.002) in the normal peripheral zone compared to the peripheral zone with prostate cancer.Conclusion: Differences in T2 and ADC between benign and malignant tissue are consistent with in vivo data. High-resolution, high-field MRI has the potential to improve the detection and identification of prostate structures. The protocols and techniques developed in this study could augment routine pathological analysis of surgical specimens and guide treatment of prostate cancer patients.Key Words: prostate cancer; prostate specimen; MRI J. Magn. Reson. Imaging 2011;34:956-961.

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Benefit of Adjuvant Radiation Therapy for Localized Prostate Cancer With a Positive Surgical Margin

Cited by 101 publications

References 33 publications

Review The role of postoperative radiotherapy in prostate cancer patients

Review The role of postoperative radiotherapy in prostate cancer patients

Prostate Cancer

High‐resolution MRI of excised human prostate specimens acquired with 9.4T in detection and identification of cancers: Validation of a technique

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