Identification of Patients With Prostate Cancer Who Benefit From Immediate Postoperative Radiotherapy: EORTC 22911

Kwast, Theodorus H. van der; Bolla, M.; Poppel, Hendrik Van; Cangh, Paul Van; Vekemans, K.; Pozzo, L. Da; Bosset, Jean-François; Kurth, K. H.; Schröder, Fritz H.; Collette, Laurence

doi:10.1200/jco.2006.10.4067

Cited by 274 publications

(155 citation statements)

References 41 publications

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“…6 The effectiveness of adjuvant radiation therapy in preventing PSA relapse and metastasis has been described in several retrospective 7,8,9 and prospective 10,11 studies, with some studies also attempting to determine factors that would predispose patients to a positive response to adjuvant therapy. [12][13][14] The long-term follow-up of the Southwest Oncology Group adjuvant radiation therapy trial (SWOG 8794/RTOG 9019) with 12-year data 15 16 Given the modest duration of this study's follow-up, the long-term risk of metastatic disease is not yet known.…”

Section: Resultsmentioning

confidence: 99%

Counseling patients about sexual health when considering post-prostatectomy radiation treatment

et al. 2009

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Prostate cancer is the second most frequently diagnosed cancer in men in the United States. Many men with clinically localized prostate cancer survive for 15 years or more. Although early detection and successful definitive treatments are increasingly common, a debate regarding how aggressively to treat prostate cancer is ongoing because of the effect of aggressive treatment on the quality of life, including sexual functioning. We examined current research on the effect of post-prostatectomy radiation treatment on sexual functioning, and suggest a way in which patient desired outcomes might be taken into consideration while making decisions with regard to the timing of radiation therapy after prostatectomy.

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Section: Resultsmentioning

confidence: 99%

Counseling patients about sexual health when considering post-prostatectomy radiation treatment

et al. 2009

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“…In fact, a subset analysis of the European Organization for Research and Treatment of Cancer randomized trial 22911 found that the presence of a positive margin was the strongest predictor of prolonged BCR-free survival in patients who received adjuvant RT after RRP, although in the manuscript the authors also conceded that 'it is not certain that PSMs add to the risk of actual local recurrence or systemic disease.' 31 Meanwhile, a recent retrospective investigation noted improved overall survival in patients with organconfined, margin-positive disease who received adjuvant RT, although only 17 patients were included in the treatment group. 32 Further fueling the controversy regarding the timing of secondary treatment for patients with a positive margin at RRP are contemporary data, suggesting that SP 33 and prostate cancer mortality 34 may be decreased with the administration of salvage RT in patients who experience BCR after RRP.…”

Section: Discussionmentioning

confidence: 99%

Clinicopathological predictors of systemic progression and prostate cancer mortality in patients with a positive surgical margin at radical prostatectomy

Boorjian

Tollefson

Rangel

et al. 2011

Prostate Cancer Prostatic Dis

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BACKGROUND: Although a positive surgical margin (PSM) at radical prostatectomy (RRP) has been consistently linked to an increased risk of biochemical recurrence, the impact of margin status on patient survival continues to be debated. We evaluated long-term outcomes of patients with a PSM at RRP and determined predictors of systemic progression (SP) and mortality in these men. METHODS:We reviewed our institutional registry of 16 749 patients who underwent RRP between 1990 and 2008 to identify 2895 patients with a PSM. Median follow-up was 10.6 years. Postoperative survival was estimated using the Kaplan-Meier method. Cox proportional hazard regression models were used to analyze clinicopathological variables associated with SP and death from prostate cancer. RESULTS:A 15-year SP-free and cancer-specific survival was 90 and 93%, respectively. On multivariate analysis, higher tumor volume, increased pathological Gleason score and advanced pathological tumor stage were associated with significantly increased risks of SP and death from prostate cancer, whereas number and location of PSM did not predict mortality. CONCLUSIONS:The risks of SP and prostate cancer death in patients with a PSM remain low on long-term follow-up. Tumor variables are the primary determinants of cancer death. These results should be considered when evaluating patients with a PSM for adjuvant therapy.

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“…In fact, other studies have shown that patients with a positive surgical margin might benefit more from radiation therapy than patients with a negative margin but who had other risk factors, such as ECE or seminal vesicle invasion. 32 This suggests that predictors for success of Figure 2 Nomogram for the prediction of biochemical recurrence (BCR) after radical prostatectomy. Instructions: draw a perpendicular line from the patient's value to the 'Points' scale on the top of the nomogram.…”

Section: Discussionmentioning

confidence: 99%

Race and prostate weight as independent predictors for biochemical recurrence after radical prostatectomy

Schroeck

Sun

Freedland

et al. 2008

Prostate Cancer Prostatic Dis

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We hypothesized that factors beyond pathological stage, grade, PSA and margin status would be important predictors of biochemical recurrence (BCR) after radical prostatectomy (RP). A cohort of 3194 patients who underwent RP between 1988 and 2007 and who had neither neoadjuvant therapy nor postoperative adjuvant hormonal therapy was retrieved from the Duke Prostate Center database. Age, prostate-specific antigen (PSA), pathological Gleason score (pG), lymph node status, seminal vesicle invasion (SVI), extracapsular extension (ECE), positive surgical margin (PSM) status, year of surgery, race, adjuvant radiation therapy (XRT), percent tumor involvement in the RP specimen and prostate weight were evaluated as possible predictors of BCR in multivariate Cox regression analysis. BCR was defined as a PSA of 0.2 ng ml À1 or higher at least 30 days after surgery. A nomogram was developed from the Cox model. Predictive accuracy was obtained by calculating bias-corrected Harrell's c and by bootstrap calibration. In multivariate analysis, PSA (hazard ratio 1.39 (95% confidence interval 1.29-1.51)), ECE (1.22 (1.04-1.44)), pG score (1.38 (1.14-1.68), 2.23 (1.76-2.84), 2.69 (2.12-3.40) for pG 3 þ 4, 4 þ 3, 47, respectively), SVI (1.72 (1.40-2.12)), PSM (2.05 (1.73-2.42)), year of surgery (0.65 (0.54-0.77)), African-American race (1.37 (1.13-1.66)), adjuvant ) and prostate weight (0.83 (0.76-0.92)) were identified as independent predictors of BCR (Pp0.018 for all factors). Predictive accuracy of the nomogram was 0.75. Race and prostate weight were independent predictors for BCR after RP. By incorporating these variables, we developed a nomogram, which provides a highly accurate means for estimating risk of BCR after RP.

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Identification of Patients With Prostate Cancer Who Benefit From Immediate Postoperative Radiotherapy: EORTC 22911

Abstract: Provided careful pathology of the prostatectomy is performed, our results suggest that immediate postoperative radiotherapy might not be recommended for prostate cancer patients with negative surgical margins. These findings require validation on an independent data set.

Cited by 274 publications

References 41 publications

Counseling patients about sexual health when considering post-prostatectomy radiation treatment

Counseling patients about sexual health when considering post-prostatectomy radiation treatment

Clinicopathological predictors of systemic progression and prostate cancer mortality in patients with a positive surgical margin at radical prostatectomy

Race and prostate weight as independent predictors for biochemical recurrence after radical prostatectomy

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