- 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.
- 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.
- 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.
- 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.