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

Abstract

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.

A Multi-Institutional Matched-Control Analysis of Adjuvant and Salvage Postoperative Radiation Therapy for pT3-4N0 Prostate Cancer

“…These studies confirm earlier retrospective observations of high-risk patients, for whom early ART showed benefit in decreasing biochemical failure. 6-12 Randomized trials comparing ART and SRT after RP with adverse pathologic features have not been performed, but several single-institution retrospective studies have demonstrated improved biochemical control with ART. 13-15 …”

Prostate Cancer

“…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.…”

“…[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%.…”

“…774,775,[777][778][779][780] However, this may be the result of differences in patient selection, time trends in disease presentation and therapeutic approach, inadequate patient numbers for conclusive statistical analysis, insufficient follow-up, and the confounding effect of androgen suppression therapy. 778,779,783 Three randomized clinical trials evaluated adjuvant RT (Table 53- 16), and these studies provide the highest level evidence on outcomes. 778,779,783 Three randomized clinical trials evaluated adjuvant RT (Table 53- 16), and these studies provide the highest level evidence on outcomes.…”

A Multi-Institutional Matched-Control Analysis of Adjuvant and Salvage Postoperative Radiation Therapy for pT3/4N0 Prostate Cancer

“…These studies confirm earlier retrospective observations of high-risk patients, for whom early ART showed benefit in decreasing biochemical failure. [6][7][8][9][10][11][12] Randomized trials comparing ART and SRT after RP with adverse pathologic features have not been performed, but several single-institution retrospective studies have demonstrated improved biochemical control with ART. [13][14][15] This study attempts to mimic a randomized trial through case matching in a retrospective multi-institutional cohort, and demonstrates a significant reduction in biochemical failure for ART compared with SRT.…”