Biochemical disease-free survival following adjuvant and salvage irradiation after radical prostatectomy

To determine the timing and patterns of late recurrence after radical prostatectomy (RP) alone or RP plus adjuvant radiotherapy (RT). Between 1970 and 1983, 159 patients underwent RP for newly diagnosed adenocarcinoma of the prostate and were found to have positive surgical margins, extracapsular extension and/or seminal vesicle invasion. Of these, 46 received adjuvant RT and 113 did not. The RT group generally received 45-50 Gy to the whole pelvis, then a boost to the prostate bed (total dose of 55-65 Gy). In the RP group, 62% received neoadjuvant/adjuvant androgen deprivation vs 17% in the RT group. Patients were analyzed with respect to timing and patterns of failure. Only one patient was lost to follow-up. The median follow-up for surviving patients was nearly 20 years. The median time to failure in the surgery group was 7.5 vs 14.7 years in the RT group (P ¼ 0.1). Late recurrences were less common in the surgery group than the RT group (9 and 1% at 10 and 15 years, respectively vs 17 and 9%). In contrast to recurrences, nearly half of deaths from prostate cancer occurred more than 10 years after treatment. Deaths from prostate cancer represented 55% of all deaths in these patients. Recurrences beyond 10 years after RP in this group of patients were relatively uncommon. Despite its long natural history, death from prostate cancer was the most common cause of mortality in this population with locally advanced tumors, reflecting the need for more effective therapy.

Section: Discussionsupporting

confidence: 75%

Section: Introductionmentioning

confidence: 99%

Timing and patterns of recurrences and deaths from prostate cancer following adjuvant pelvic radiotherapy for pathologic stage T3/4 adenocarcinoma of the prostate

Anscher

Clough

Robertson

et al. 2006

“…In this group, ERT might be a very good option of adjuvant treatment after RPX. 38 Our data also suggest that in patients treated with ERT, adjuvant therapy by the means of hormonal withdrawal, is beneficial. The different mechanisms represented by radiotherapy and hormonal deprivation concerning control or killing of malignant cells suggest a rationale for their combined use.…”

Section: Radiation or Surgery In Advanced Prostate Cancer R Kuefer Et Alsupporting

confidence: 57%

Comparison of external radiation therapy vs radical prostatectomy in lymph node positive prostate cancer patients

Kuefer

Volkmer

Loeffler

et al. 2004

Introduction: Treatment options for lymph node positive prostate cancer are limited. We retrospectively compared patients who underwent external radiotherapy (ERT) to patients treated by radical prostatectomy (RPX). Materials and Methods: A total of 102 lymph node positive patients from the RPX series at Ulm University were evaluated. In all, 76 patients received adjuvant androgen withdrawal as part of their primary treatment. In the ERT group, 44 patients were treated at the University of Michigan using a fractionated regimen. Of these, 21 patients received early adjuvant hormonal therapy. Patients with neoadjuvant therapy before RPX or ERT were excluded. Results: In the RPX group, PSA nadir (nadirp0.2 vs 40.2 ng/ml) showed a strong association with outcome. In the ERT group, pretreatment PSA was an independent predictor of outcome (P ¼ 0.04) and patients with adjuvant hormonal therapy had a significant longer recurrence-free interval compared to patients without adjuvant therapy (P ¼ 0.004). Comparing only patients with adjuvant hormonal treatment after cancer-specific therapy, the ERT-treated patients had a borderline longer PSA recurrence-free survival time compared to the RPX-treated patients (P ¼ 0.05). Conclusions: In case of positive lymph nodes, RPX and ERT might be considered and need to be explained to the patient. For future treatment decisions, the presented findings and a potential survival benefit need to be evaluated in a larger prospective setting.

“…While a number of articles evaluating outcome with RT with or without AB for patients with pT3-4 disease [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] were found, there was only one article that described outcome with AB alone for pT3bN0M0 disease. 23 A single study was found that prospectively compared postoperative RT with postoperative RT þAB.…”

Section: Methodsmentioning

confidence: 99%

“…[9][10][11][12][13][14][15][16][17][18][19] This is not the case, however, in patients with SVI. In fact, SVI is a consistent poor predictor of disease control after postoperative RT with 5-y biochemical control rates of only 11-60% compared with 45-100% in patients without SVI (Table 4).…”

Section: Postoperative Rtmentioning

confidence: 99%

What is the best postoperative treatment for patients with pT3bN0M0 adenocarcinoma of the prostate?

Kasibhatla

Peterson

Anscher

2005

The purpose of this paper to identify the optimal therapy after radical prostatectomy (RP) for patients with adenocarcinoma of the prostate invading the seminal vesicles (pT3bN0M0 or SVI). A PubMed search using the keywords 'prostate', 'seminal vesicle', 'prostatectomy', 'radiotherapy', 'androgen blockade' was performed to identify literature regarding rates of disease failure in patients with SVI who are observed or treated with androgen blockade (AB), radiotherapy (RT) or RT þAB after RP. The outcome of 68 patients treated at Duke University with post-operative AB, RT or RT þAB for pT3bN0M0 is also presented. More than 70% of patients with SVI develop disease recurrence after surgery. For many, recurrence occurs within 2 y after RP. These patients have poor control rates with postoperative RT alone. While experience with AB and RT þAB is limited, control rates are generally superior to RT alone. At Duke University, after a median followup of nearly 4 y, patients treated with RT þAB or AB alone for pT3bN0M0 achieved better 5-y progression-free survival (PFS) compared with those who received RT alone (78 and 68 vs 30%, P ¼ 0.03 and 0.046, respectively). There was no PFS difference between those who received AB alone or RT þAB (68 vs 78%, P ¼ 0.5). Seminal vesicle invasion confers a poor prognosis after RP. SVI is a consistent predictor of poor outcome after RT. The limited data available examining AB and RT þAB in pT3bN0M0 disease, including data from Duke University, are encouraging. Nonetheless, postoperative AB, RT and RT þAB for pT3bN0M0 disease require prospective evaluation, as RP alone is rarely curative.