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AUA 2018

AUA 2018: Adjuvant and Salvage Radiation Therapy After Radical Prostatectomy and the Impact on Long-Term Outcomes

San Francisco, CA (UroToday.com) For men with adverse pathologic features at the time of radical prostatectomy, the role of adjuvant as compared to salvage radiotherapy is hotly debated. While level 1 evidence has shown that adjuvant radiotherapy reduces biochemical recurrence, metastasis and possibly death when compared to a ‘wait and see’ approach, its merits compared to a salvage approach are currently still be evaluated. Using a large cohort of patients who underwent radical prostatectomy at three high volume urologic oncology centers in Europe and the United States, Dr. Bandini and colleagues presented a moderated poster at the American Urologic Association Annual Meeting describing trends in the use of adjuvant and salvage radiotherapy. 



Among the three centers participating in this study, 40,223 patients were identified who had undergone radical prostatectomy between 2001 and 2016. The strategy for post-operative radiotherapy was decided on the basis of disease characteristics and the preference of the treating physician. The authors defined adjuvant radiotherapy (ART) as that which was delivered within 6 months of radical prostatectomy. Salvage radiotherapy (SRT) was defined on the basis of biochemical recurrence with two consecutive PSA measurements which exceeded 0.2 ng/mL. The authors examined the overall rates of ART and SRT use, as well as the annual percentage change. They then performed subgroup analyses among patients with pT3 disease, pT2R1 disease and pN1 disease. The authors examined the association between year of diagnosis and utilization of ART vs SRT using logistic regression analyses and the association between year of diagnosis and cancer specific mortality using Cox regression analyses. 

Among the 40,223 men, potentially adverse features were identified in 18,139 (45%): 11,577 (29%) had pT3 disease, 3326 (8%) had pT2R1 disease, and 3236 (8%) had pN1 disease. Of these, ART was administered for 1862 (16%) of patients with pT3 disease, 191 (6%) of patients with pT2R1 disease, and 943 (29%) of patients with pN1 disease. Among the remaining patients, 4588 (11%) experienced biochemical recurrence and 2484 (54%) of these received SRT. 

Interestingly, the authors note that the annual rate of ART decreased over the study period, from 8% in 2001 to 1.6% in 2016, an annual decrease of 2.6% (p=0.02). This change was noted across each of the subgroups: pT3 (-4.1%, p<0.001), pT2R1 (-7%, p<0.001), and pN1 (-5.6%, p<0.001). There was a corresponding increase in the use of SRT for patients with pT2R1 (3.3%, p=0.001) and pN1 (3.3%, p=0.011) but not those with pT3 disease. This decrease in the use of ART over time persisted on multivariable analyses. Year of diagnosis was not significantly associated with cancer specific mortality (HR = 0.99, p=0.7). 

The authors conclude that while rates of ART are decreasing with corresponding increases in the use of SRT, no appreciable effect on mortality has been observed. 

Presented By: Marco Bandini 
Co-authors: Paolo Dell’Oglio, Nicola Fossati, Giorgio Gandaglia, Carlo Andrea Bravi, Emanuele Zaffuto, Armando Stabile, Elio Mazzone, Felix Preisser, Pierre I. Karakiewicz, Matteo Soligo, Jeffrey R. Karnes, Markus Graefen, Derya Tilki, Francesco Montorsi, Alberto Briganti 

Written by: Christopher J.D. Wallis, Urology Resident, University of Toronto, Twitter: @WallisCJDat the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA