To determine trends and predictors of adjuvant therapy in patients with adverse features at radical prostatectomy (RP), and to investigate the associations of adjuvant therapy and adverse feature type with survival.
From the CaPSURE registry (1990-2017), 2209 men with adverse features (pT3N0M0 disease and/or positive surgical margins), and 108 men with positive lymph nodes (pN1) at RP were identified. Temporal trends were evaluated, and predictors of adjuvant therapy were assessed with multivariate logistic regression. Kaplan-Meier analysis and competing risks regression were used to test cumulative incidence and risk of all-cause and prostate cancer specific mortality (PCSM).
Of 2209 men with adverse features and pN0 disease, 89 (4.0%), 82 (3.7%), and 30 (1.4%) received adjuvant external beam radiation therapy (ERBT) alone, androgen deprivation therapy (ADT) alone, or combined EBRT and ADT, respectively. Of 108 men with pN1 disease, 54 (50%) received ADT with or without EBRT. Adjuvant treatment for patients with adverse features decreased from 13.3% (1990-1994) to 6% or less (2005-2017, ptrend <0.001). Patients with margin positive pT3a (OR, 4.13; 95% CI 2.21-7.73; p<0.01), and margin positive pT3b disease (OR, 7.09; 95% CI 3.66-1.73; p<0.01) had greater odds of receiving adjuvant therapy compared to patients with margin negative pT3a disease. Adverse feature type was associated with PCSM in univariate analysis (log-rank P<0.01), but not in competing risks regression (p=0.06).
Adjuvant therapy declined for men with adverse features at RP. Providers do not treat all adverse feature types the same way, despite broad treatment recommendations in guidelines.
Urology. 2019 May 28 [Epub ahead of print]
Ashwin S Balakrishnan, Shoujun Zhao, Janet E Cowan, Jeanette M Broering, Matthew R Cooperberg, Peter R Carroll
Department of Urology, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California, United States. Electronic address: ., Department of Urology, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California, United States. Electronic address: ., Department of Urology, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California, United States. Electronic address: ., Department of Urology, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California, United States. Electronic address: ., Department of Urology, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California, United States; Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, California, United States. Electronic address: ., Department of Urology, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California, United States. Electronic address: .