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2019 SUO Annual Meeting

SUO 2019: Radiotherapy after Radical Prostatectomy: Effect of Timing of Post-Prostatectomy Radiation on Functional Outcomes

Washington, DC (UroToday.com)  Radical prostatectomy (RP) is curative for many patients undergoing surgery for prostate cancer.1 However, patients with adverse pathologic findings experience up to a 60% risk of recurrence at 10 years and may require subsequent radiation therapy.2 Adjuvant radiotherapy2 and salvage radiotherapy3,4 have been shown to improve biochemical control and may improve metastasis-free survival.   The benefit of radiotherapy is maximized when administered early following biochemical recurrence.4 However, observational data would suggest that functional outcomes may be compromised by early postoperative radiotherapy.5 In a poster presentation at the Society of Urologic Oncology meeting, Dr. Heather Huelster and colleagues assessed the effect of the timing of post-prostatectomy radiotherapy on patient-reported sexual, urinary and bowel related outcomes.

The authors relied on the Comparative Effectiveness Analysis of Surgery and Radiation (CEASAR) study, a prospective, population-based observational study of men with localized prostate cancer who were enrolled between 2011 and 2012. For the purpose of this analysis, the authors identified all patients who were initially treated with radical prostatectomy. They assessed patient-reported sexual, urinary, and bowel function using the EPIC-26 questionnaire at baseline, 6-months, 12-months, 36-months, and 60-months.

Among 1482 patients who underwent radical prostatectomy, the majority received surgery alone. 170 patients (11.5%) received post-operative radiotherapy. In adjusted linear models, adjuvant and salvage radiotherapy were associated with worse sexual function, urinary function, bowel function, and hormonal function compared to radical prostatectomy alone at 5 years.

SUO 2019 functional outcomes post radical prostatectomy

The authors found that the time from surgery to initiation was associated with a significant change in sexual function, with the effect most mitigated by radiation administration after 24 months following radical prostatectomy.

Given the recent data on adjuvant and early salvage radiotherapy, these data would support delaying the administration of post-operative radiotherapy with equivalent oncologic outcomes and improved functional outcomes.

Presented by: Heather L Huelster, MD, Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee 

Written by: Christopher J.D. Wallis, MD, PhD, FRCSC Contact: @WallisCJD on Twitter at the 20th Annual Meeting of the Society of Urologic Oncology (SUO), December 4 - 6, 2019, Washington, DC


References:
1. Bianco FJ, Jr., Scardino PT, Eastham JA. Radical prostatectomy: long-term cancer control and recovery of sexual and urinary function ("trifecta"). Urology 2005; 66(5 Suppl): 83-94.
2. Thompson IM, Valicenti RK, Albertsen P, et al. Adjuvant and salvage radiotherapy after prostatectomy: AUA/ASTRO Guideline. The Journal of urology 2013; 190(2): 441-9.
3. Stephenson AJ, Shariat SF, Zelefsky MJ, et al. Salvage radiotherapy for recurrent prostate cancer after radical prostatectomy. JAMA : the journal of the American Medical Association 2004; 291(11): 1325-32.
4. Trock BJ, Han M, Freedland SJ, et al. Prostate cancer-specific survival following salvage radiotherapy vs observation in men with biochemical recurrence after radical prostatectomy. JAMA : the journal of the American Medical Association 2008; 299(23): 2760-9.
5. Suardi N, Gallina A, Lista G, et al. Impact of adjuvant radiation therapy on urinary continence recovery after radical prostatectomy. European urology 2014; 65(3): 546-51.