Prostate cancer: adjuvant radiotherapy cuts risk for biochemical recurrence

  • Eur Urol
  • 29 Aug 2019

  • curated by Deepa Koli
  • Univadis Clinical Summaries
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Takeaway

  • Adjuvant radiotherapy (ART) following radical prostatectomy delays biochemical recurrence in patients with prostate cancer with positive margins or extracapsular extension.
  • ART carries toxicity risk, and prostate-specific antigen (PSA) recurrence-free survival (RFS) benefit does not translate to extended OS.

Why this matters

  • Consensus is lacking on treatment after radical prostatectomy in this population.

Study design

  • Randomized, open-label, parallel-group trial of 250 patients with prostate cancer (stage pT2 with positive margins or pT3aN0M0 without seminal vesicle invasion), randomly assigned 1:1 to either ART or observation after radical prostatectomy.
  • Primary endpoint was biochemical RFS.
  • Funding: The Finnish Medical Foundation, Finnish Cancer Organizations, Ida Montini Foundation; others.

Key results

  • Median follow-up time was 9.3 years in the ART group and 8.6 years in the observation group.
  • 10-year biochemical RFS was 82% in the ART group and 61% in the observation group (aHR, 0.30; P<.001>
  • No difference was observed in 10-year OS (HR, 0.69; P=.4) and cancer-specific survival (HR, 1.00; P=1).
  • 37 of 43 patients with biochemical recurrence received salvage radiotherapy.
    • Grade 3 adverse event rate was significantly higher with ART (56% vs 40%; P=.016); erectile dysfunction and urinary incontinence were most common.
    • 1 patient receiving ART experienced grade 4 toxicity.

    Limitations

    • Small sample size.

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