Long-term complications in men who have early or late radiotherapy after radical prostatectomy.

Abstract

Introduction: Choosing adjuvant radiotherapy (RT) or salvage RT after radical prostatectomy (RP) for locally advanced prostate cancer is controversial. Performing RT early after RP may increase the risk of urinary complications compared to RT performed later. We evaluated the urinary complication rates of men treated with surgery followed by early or late RT. Methods: Using a retrospective chart review, we compared rates of urinary incontinence (UI), bladder neck contracture (BNC), or urethral stricture in men with prostate cancer treated with early RT (<6 months after RP) or late RT (≥6 months after RP), 3 years after RT. Results: In total, 652 patients (between 2000 and 2007) underwent early RT (162,24.8%) or late RT (490, 75.2%) after RP. The mean time to early RT was 3.6 months (range: 1-5 months) and to late RT was 30.1 months (range: 6-171 months). At 3 years post-RT, UI rates were similar in the early RT and the late RT groups (24.5% vs. 23.3%, respectively, p = 0.79). Prior to RT, 27/652 (4%) patients had a BNC and 11/652 (1.7%) had a urethral stricture, of which only 1 BNC persisted at 3 years post-RT. After RT, 17/652 (2.6%) BNC and 4/652 (0.6%) urethral stricture developed; of these, 6 BNC and 2 urethral strictures persisted at 3 years. Conclusion: Rates of UI, BNC, and urethral stricture were similar with early and late RT at 3 years post-RT. These findings suggest that the timing of RT after RP does not alter the incidences of these urinary complications and can aid in the decision-making process regarding adjuvant RT versus salvage RT.

An update on best practice in the diagnosis and management of post-prostatectomy anastomotic strictures

“…Sowerby and colleagues reported a VUAS rate following adjuvant or salvage radiotherapy of 2.6%. 30 Although they demonstrated no difference in rate when delivered in an adjuvant or salvage setting, delaying the administration of radiation after RP has been shown by others to decrease the rate of VUAS. 31,32 Several patient factors have been associated with VUAS in different surgical series.…”

Profile of Radiation Therapy after Radical Prostatectomy: Experience in a Tertiary Hospital in Jakarta, Indonesia

“…Whereas, retrospective studies focusing on patients treated with SRT showed that this radiotherapy might lead to grade 2 or higher genitourinary toxicities in up to 20% of the patients [34,35]. In addition, previous studies that compared the safety profile of postoperative ART and SRT failed to show significant differences between both approaches [35,36].…”

Artificial urinary sphincter erosion after radical prostatectomy in patients treated with and without radiation

“…In that series, only 96 of the 652 (15%) patients received IMRT. 24 It is possible that over the next 10 years more patients will be treated with IMRT rather than 3D-CRT, which may reduce the incidence of cuff erosion. Nevertheless, from December 2001 to January 2012, our cohort of patients treated with radiation after RP who subsequently required an AUS had a significantly increased risk of cuff erosion compared to those who did not receive radiotherapy.…”