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Radiation therapy following surgery for pT3-4N0 disease

Posted on August 12, 2008 by Sitemaster

It has long been unclear what the optimal radiation treatment was for men with pathologic T3-4N0 prostate cancer following radical prostatectomy (RP). Trabulsi et al. have recently conducted a multi-institutional analysis of the relative values of early adjuvant radiation therapy (ART) vs. delayed (salvage) radiation therapy (SRT) in such patients.

The study was based on a group of patients undergoing ART who were then compared with a matched control group undergoing SRT after biochemical failure. A multi-institutional database of 2,299 patients was available. From this database, 449 patients with pT3-4N0 disease were eligible for inclusion, including 211 patients receiving ART and 238 patients receiving SRT. Patients were matched in a 1:1 ratio according to preoperative PSA level, Gleason score, seminal vesicle invasion, surgical margin status, and follow-up from date of surgery.

The authors report the following results:

  • A total of 192 patients were matched (96:96).
  • The median follow-up was 94 months from surgery and 73 months from completion of radiotherapy.
  • There was a significant reduction in biochemical failure with ART compared with SRT.
  • The 5-year freedom from biochemical failure (FFBF) from time of surgery was 75 percent after ART, compared with 66 percent for SRT.
  • The 5-year FFBF from the end of radiotherapy was 73 percent after ART, compared with 50 percent after SRT.
  • From the end of radiotherapy, SRT and Gleason score ≥ 8 were independent predictors of diminished FFBF.
  • From the date of surgery, Gleason score ≥ 8 was a significant predictor of FFBF.

The authors conclude that early ART significantly reduces the risk of long-term biochemical progression after RP compared with SRT for patients with pT3-4N0 prostate cancer . They also note that Gleason score ≥ 8 was the only factor associated with metastasic progression on multivariate analysis.

The “New” Prostate Cancer InfoLink considers this to be an important paper that further clarifies the role of post-surgical radiotherapy in men with pathologic T3-4 disease. We believe these data should be confirmed through the development of a well-designed prospective clinical trial. However, for the present there are now sound data on which to advise patients that early ADT is associated with better 5-year outcomes than delayed (salvage) radiation, although individual patient issues clearly still need to be taken into account in the decision process.


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