A Multi-Institutional Matched-Control Analysis of Adjuvant and Salvage Postoperative Radiation Therapy for pT3-4N0 Prostate Cancer

Edouard J. Trabulsi, Richard K Valicenti, Alexandra L. Hanlon, Thomas M. Pisansky, Howard M. Sandler, Deborah A. Kuban, Charles N. Catton, Jeff M. Michalski, Michael J. Zelefsky, Patrick A. Kupelian, Daniel W. Lin, Mitchell S. Anscher, Kevin M. Slawin, Claus G. Roehrborn, Jeffrey D. Forman, Stanley L. Liauw, Larry L. Kestin, Theodore L. DeWeese, Peter T. Scardino, Andrew J. StephensonAlan Pollack

Research output: Contribution to journalArticle

89 Scopus citations

Abstract

Objectives: It is unclear whether postoperative salvage radiation therapy (SRT) and early adjuvant radiotherapy (ART) after radical prostatectomy lead to equivalent long-term tumor control. We studied a group of patients undergoing ART by comparing them with a matched control group undergoing SRT after biochemical failure. Methods: Using a multi-institutional database of 2299 patients, 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 prostate-specific antigen Gleason score, seminal vesicle invasion, surgical margin status, and follow-up from date of surgery. Results: A total of 192 patients were matched (96:96). The median follow-up was 94 months from surgery and 73 months from RT completion. There was a significant reduction in biochemical failure with ART compared with SRT. The 5-year freedom from biochemical failure (FFBF) from surgery was 75% after ART, compared with 66% for SRT (hazard ratio [HR] = 1.6, P = .049). The 5-year FFBF from the end of RT was 73% after ART, compared with 50% after SRT (HR = 2.3, log rank [LR] P = .0007). From the end of RT, 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. Conclusions: Early ART for pT3-4N0 prostate cancer significantly reduces the risk of long-term biochemical progression after radical prostatectomy compared with SRT. Gleason score ≥8 was the only factor on multivariate analysis associated with metastasic progression.

Original languageEnglish (US)
Pages (from-to)1298-1302
Number of pages5
JournalUrology
Volume72
Issue number6
DOIs
StatePublished - Dec 2008
Externally publishedYes

ASJC Scopus subject areas

  • Urology

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    Trabulsi, E. J., Valicenti, R. K., Hanlon, A. L., Pisansky, T. M., Sandler, H. M., Kuban, D. A., Catton, C. N., Michalski, J. M., Zelefsky, M. J., Kupelian, P. A., Lin, D. W., Anscher, M. S., Slawin, K. M., Roehrborn, C. G., Forman, J. D., Liauw, S. L., Kestin, L. L., DeWeese, T. L., Scardino, P. T., ... Pollack, A. (2008). A Multi-Institutional Matched-Control Analysis of Adjuvant and Salvage Postoperative Radiation Therapy for pT3-4N0 Prostate Cancer. Urology, 72(6), 1298-1302. https://doi.org/10.1016/j.urology.2008.05.057