Radiotherapy after radical prostatectomy: Effect of timing of postprostatectomy radiation on functional outcomes

Huelster, Heather; Laviana, Aaron A.; Joyce, Daniel; Huang, Li; Zhao, Zhiguo; Koyama, Tatsuki; Hoffman, Karen E.; Conwill, Ralph; Goodman, Michael; Hamilton, Ann S.; Wu, Xiao Cheng; Paddock, Lisa E.; Stroup, Antoinette M.; Cooperberg, Matthew R.; Hashibe, Mia; O’Neil, Brock; Kaplan, Sherrie H.; Greenfield, Sheldon; Penson, David F.; Barocas, Daniel A.

doi:10.1016/j.urolonc.2020.06.022

Cited by 10 publications

(21 citation statements)

References 29 publications

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“…For patients undergoing radical prostatectomy, PI‐RADS scores could help set expectations for the likelihood of needing adjuvant therapy after surgery. Approximately 25%–41% of men will develop local recurrence with PSA elevation within 10 years after radical prostatectomy 10 . Yet despite this risk, adjuvant therapy is utilized in only 6%–51% of men and is declining over time 11,12 .…”

Section: Introductionmentioning

confidence: 99%

“…Approximately 25%-41% of men will develop local recurrence with PSA elevation within 10 years after radical prostatectomy. 10 Yet despite this risk, adjuvant therapy is utilized in only 6%-51% of men and is declining over time. 11,12 Although postoperative treatment decisions rely on final pathology, PI-RADS scores could help minimize treatment delays by identifying higher-risk patients and enabling urologists to set up referrals in advance for medical or radiation oncologists.…”

Section: Mri Pi-rads Prostate Cancer Upstage 1 | Introductionmentioning

confidence: 99%

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Preoperative MRI PI‐RADS scores are associated with prostate cancer upstaging on surgical pathology

et al. 2021

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Introduction: Prostate Imaging Reporting and Data System (PI-RADS) scores can help identify clinically significant prostate cancer and improve patient selection for prostate biopsies. However, the role of PI-RADS scores in patients already diagnosed with prostate cancer remains unclear. The purpose of this study was to evaluate the association of PI-RADS scores with prostate cancer upstaging. Upstaging on final pathology harbors a higher risk for biochemical recurrence with important implications for additional treatments, morbidity, and mortality.Methods: All patients from a single high-volume institution who underwent a prostate multiparametric magnetic resonance imaging and radical prostatectomy between 2016 and 2020 were included in this retrospective analysis. Univariable and multivariable analyses were conducted to investigate potential associations with upstaging events, defined by pT3, pT4, or N1 on final pathology. A logistic regression model was constructed for the prediction of upstaging events based on PI-RADS score, prostate-specific antigen density (PSA-D), and biopsy Gleason grade groups.We built receiver operative characteristic (ROC) curves to measure the area under the curve of different predictive models.Results: Two hundred and ninety-four patients were included in the final analysis.Upstaging events occurred in 137 (46.5%) of patients. On univariable analysis, patients who were upstaged on final pathology had significantly higher PI-RADS scores (odds ratio [OR] 2.34 95% confidence interval [CI] 1.64-3.40, p < 0.001) but similar PSA-D (OR 2.70 95% 0.94-8.43, p = 0.188) compared with patients who remained pT1 or pT2 on final pathology. On multivariable analysis, PI-RADS remained independently significantly associated with upstaging, suggesting it is an independent risk predictor for upstaging. Lymph node metastasis only occurred in patients with PI-RADS 4 or 5 lesions (n = 15). Our model using PSA-D, biopsy Gleason grade, and PI-RADS had a predictive AUC of 0.69 for upstaging events, an improvement from 0.59 using biopsy Gleason grade alone.Conclusion: PI-RADS scores are independent predictors for upstaging events and may play an important role in forecasting biochemical recurrence and lymph node metastasis.Modern nomograms should be updated to include PI-RADS to predict lymph node metastases and the likelihood of biochemical recurrence more accurately.

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Section: Introductionmentioning

confidence: 99%

Section: Mri Pi-rads Prostate Cancer Upstage 1 | Introductionmentioning

confidence: 99%

Preoperative MRI PI‐RADS scores are associated with prostate cancer upstaging on surgical pathology

et al. 2021

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“…This represented a landmark finding that up to half of patients could potentially avoid postoperative RT entirely, whereas RT could be safely delayed for many others to allow for maximal surgical recovery, as data suggest improved urinary and sexual outcomes with a longer interval to RT. 16 Of the 2,153 total patients analyzed in the metaanalysis, approximately 80% had pT3a/b disease, 71% had positive margins, and 78% and 15% had Gleason 7 and $ 8 disease, respectively. However, only 3.1% were pN1, due to exclusion in both the GETUG-17 and RAVES trials.…”

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confidence: 97%

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confidence: 99%

Adjuvant Radiation for Pathologically Node-Positive Prostate Cancer: Evidence When Early Salvage May Not Be Early Enough

Cao

Deville

2022

JCO

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“…In addition, generalizability of the results is impeded by diverging conceptions of the time frames under which RT would be deemed “adjuvant”. 14–16 Noteworthy, none of these studies focused on differences in general health-related quality of life (HRQOL) between aRT and sRT. Encouraged by this paucity of data, we conducted this propensity score matched analysis of contemporary patients with adverse pathological findings after RP, who were scheduled for early RT (eRT), within 6 month after RP, or observation followed by deferred RT (dRT).…”

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confidence: 99%

Timing of Radiotherapy after Radical Prostatectomy: Effects on Health-Related Quality of Life

et al. 2021

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Purpose:The optimal timing of radiotherapy (RT) after radical prostatectomy (RP) remains controversial with unknown impact on health-related quality of life (HRQOL). We aimed to compare the influence of early RT (eRT) and deferred RT (dRT) on HRQOL.Materials and Methods:A total of 4,511 patients were analyzed. Inclusion criteria encompassed: ≥pT3, International Society of Urological Pathology grade ≥4, or positive surgical margin. A 1:4 propensity score-matched-analysis of 1,599 patients was conducted (307: eRT, ≤6 months after RP; 1,292: dRT, >6 months after RP). Primary end point was general HRQOL (based on European Organisation for Research and Treatment of Cancer QLQ-C30). Pearson correlation and binary logistic regression models were used to estimate the impact of timing of RT on HRQOL. Functional outcome was assessed using the International Consultation on Incontinence Questionnaire, short form (ICIQ-SF) and International Index of Erectile Function (IIEF-5) questionnaires.Results:Median followup was 38 months. At 12 months and 24 months followup, general HRQOL scores were significantly higher for dRT (52.7 vs 35.5; p=0.001; 45.8 vs 37.3; p=0.026). ICIQ-SF scores were higher (8.5 vs 6.1; p=0.001; 8.4 vs 7.3; p=0.038), and IIEF-5 scores were lower (1.8 vs 4.2; p=0.001; 2.2 vs 4.4; p=0.005) for eRT at 12 months and 24 months. On multivariate-analysis, dRT was associated with superior general HRQOL at 12 months (OR 0.59, 95% CI 0.37–0.94, p=0.027) and 24 months (OR 0.64, 95% CI 0.39–0.99, p=0.043), respectively. A longer time interval between RP and RT was associated with improved general HRQOL (OR 1.09, 95% CI 1.038–1.143; p <0.001).Conclusions:dRT yields improved short-term HRQOL compared to eRT. Since longer time intervals between RP and RT predict better short-term HRQOL, our data provide further support for the concept of deferred RT at low prostate specific antigen recurrence.

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Radiotherapy after radical prostatectomy: Effect of timing of postprostatectomy radiation on functional outcomes

Cited by 10 publications

References 29 publications

Preoperative MRI PI‐RADS scores are associated with prostate cancer upstaging on surgical pathology

Preoperative MRI PI‐RADS scores are associated with prostate cancer upstaging on surgical pathology

Adjuvant Radiation for Pathologically Node-Positive Prostate Cancer: Evidence When Early Salvage May Not Be Early Enough

Timing of Radiotherapy after Radical Prostatectomy: Effects on Health-Related Quality of Life

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