ESMO 2019 — Localised prostate cancer: adjuvant radiotherapy after radical prostatectomy no better than early salvage radiotherapy


  • Jo Whelan
  • Oncology Conference reports
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Takeaway

  • Adjuvant radiotherapy (RT) after radical prostatectomy did not improve event-free survival compared with early salvage RT in men with localised prostate cancer.

Why this matters

  • The strategy of waiting for early signs of recurrence before administering RT spares many men from potentially unnecessary RT and associated adverse effects.

Key results

  • Across the 3 trials, 1074 men were randomised to adjuvant RT and 1077 men to salvage.
  • At the time of analysis, 395 (37%) had commenced salvage RT.
  • Most of the events seen were biochemical (PSA) failures.
  • Based on 248 events, the meta-analysis showed no evidence that adjuvant RT improves event-free survival compared with early salvage RT at the earliest signs of failure (HR=1.12, 95% CI = 0.88-1.42).
  • Further follow-up is needed to assess long-term definitive outcomes, including overall survival.

Study design

  • Prospective meta-analysis combining outcomes from three studies comparing adjuvant radiotherapy (RT) with early salvage RT for PSA failure in men with localised prostate cancer who have undergone radical prostatectomy.
  • Methods were defined prior to knowledge of study results using a framework for adaptive meta-analysis (FAME) methodology, including a consistent definition of PSA-driven event-free survival (EFS) across the studies.
  • Funding: UK Medical Research Council.

Limitations

  • The study population in the largest trials (RADICALS, conducted in the UK) is not generalisable to all countries, as the patients who underwent surgery had a relatively low-risk disease compared with post-surgical populations in some other regions.