Treatment outcome with adjuvant and salvage irradiation after radical prostatectomy for prostate cancer

Vicini, Frank A.; Ziaja, Ellen L.; Kestin, Larry L.; Brabbins, D.; Stromberg, Jannifer S.; Gonzalez, Jose A.; Martínez, Álvaro

doi:10.1016/s0090-4295(99)00219-8

Cited by 97 publications

(36 citation statements)

References 36 publications

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“…These findings are consistent with those of other retrospective studies reported in the literature. 1,[3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]20,22 Recently, a large randomized trial of more than 1000 patients was published with findings similar to ours, although followup to date is only 5 years. 2 It is possible that with longer follow-up, a survival advantage attributed to the use of adjuvant RT will emerge.…”

Section: Discussionsupporting

confidence: 75%

“…For patients at high risk of local failure, that is, those with positive surgical margins, adjuvant radiotherapy (RT) results in permanent local control in the majority of patients. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] Whether adjuvant RT offers an advantage in survival or reduces deaths from prostate cancer compared to radiation delivered at the time of prostate-specific antigen (PSA) recurrence remains unknown. The majority of studies, which address this issue, are small, retrospective and suffer from short follow-up.…”

Section: Introductionmentioning

confidence: 99%

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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

Prostate Cancer Prostatic Dis

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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.

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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

Prostate Cancer Prostatic Dis

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“…Although no prospective data exist, several retrospective reports have recently been published that have directly compared the results of adjuvant radiotherapy to salvage radiotherapy (i.e., therapy that is delayed until the PSA begins to rise) [12][13][14][15][16] (Table 1). Patients with overt local failure, who have a worse outcome following radiotherapy than do patients with an isolated biochemical relapse, are not included in this analysis [17].…”

Section: Adjuvant Treatment Leads To Improved Disease-free Survivalmentioning

confidence: 99%

Adjuvant radiotherapy following radical prostatectomy is more effective and less toxic than salvage radiotherapy for a rising prostate specific antigen

Anscher

2001

Intl Journal of Cancer

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SUMMARY Despite the trend toward earlier diagnosis of adenocarcinoma of the prostate, approximately 25% of men undergoing radical prostatectomy will have pathologic evidence of cancer extending outside of the prostate. These patients are at high risk for subsequent recurrence. Such relapses are almost always manifested initially as a rise in the Prostate Specific Antigen (PSA). Currently utilized PSA assays, however, will not detect a recurrence smaller than 10 7 to 10 8 cells, nor does PSA identify the site of recurrence. In contrast, the pathologic findings at the time of surgery can be used to reliably distinguish patients at risk for local recurrence from those more likely to fail distantly. Furthermore, adjuvant pelvic radiotherapy after prostatectomy, given to patients with an undetectable PSA who are at high risk for local recurrence, results in a higher disease free survival and fewer side effects than if radiotherapy is delayed until the PSA begins to rise. Thus, patients at high risk for local failure following radical prostatectomy, but at low risk for distant metastases (i.e., those with positive surgical margins and an undetectable PSA) should be offered immediate adjuvant radiotherapy.

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“…Our data, as well as that from Vicini et al, also demonstrate the indication for radiotherapy (adjuvant vs therapeutic) as an independent prognostic factor associated with biochemical control. 63 However, no other clinical, pathological, or treatment-related factors were associated with 5-y outcome in their patients. Cadeddu et al present more pessimistic data.…”

Section: Recurrence After Radical Prostatectomymentioning

confidence: 88%

Local therapy for prostate-specific antigen recurrence after definitive treatment

Meng

Carroll

2001

Prostate Cancer Prostatic Dis

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Treatment outcome with adjuvant and salvage irradiation after radical prostatectomy for prostate cancer

Cited by 97 publications

References 36 publications

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

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

Adjuvant radiotherapy following radical prostatectomy is more effective and less toxic than salvage radiotherapy for a rising prostate specific antigen

Local therapy for prostate-specific antigen recurrence after definitive treatment

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