Adjuvant Radiotherapy Versus Wait-and-See After Radical Prostatectomy: 10-year Follow-up of the ARO 96–02/AUO AP 09/95 Trial

Wiegel, Thomas; Bartkowiak, Detlef; Bottke, Dirk; Bronner, Claudia; Steiner, U.; Siegmann, Alessandra; Golz, Reinhard; Störkel, Stephan; Willich, Normann; Semjonow, Axel; Stöckle, Michael; Rübe, Christian; Rebmann, U.; Kälble, T.; Feldmann, Horst Jürgen; Wirth, Manfred P.; Hofmann, Rainer; Engenhart‐Cabillic, Rita; Hinke, Axel; Hinkelbein, W.; Miller, Kurt

doi:10.1016/j.eururo.2014.03.011

Cited by 398 publications

(296 citation statements)

References 27 publications

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“…Adjuvant radiotherapy is associated at least with improved biochemical progression-free survival in 3 randomised trials [76][77][78] although only SWOG 8794 [78] suggested improved OS. Thus, for patients classified as pT3 pN0 with a high risk of local failure due to positive margins (highest impact), pT3a or pT3b with a post-operative PSA < 0.1 ng/mL, two options can be offered in the framework of informed consent: either immediate EBRT to the surgical bed after recovery of urinary function, or monitoring followed by early salvage radiotherapy (SRT) before the PSA exceeds 0.5 ng/mL [79].…”

Section: Post-operative Ebrt After Rpmentioning

confidence: 99%

EAU-ESTRO-SIOG Guidelines on Prostate Cancer. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent

et al. 2017

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Section: Post-operative Ebrt After Rpmentioning

confidence: 99%

EAU-ESTRO-SIOG Guidelines on Prostate Cancer. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent

et al. 2017

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“…Rates of grade 2 and 3 urinary toxicity are reported to be slightly less (approximately 10% grade 2 and 5% grade 3) in both multi‐ and single‐institution studies 5, 26. In our series to date, there has only been 1 reported case of Grade 3 late GU and GI toxicity, respectively.…”

Section: Discussionmentioning

confidence: 52%

Outcomes of post‐prostatectomy radiotherapy at a Regional Cancer Centre

Nicholls

Winter

Harwood

et al. 2017

J of Medical Radiation Sci

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IntroductionTo investigate the efficacy and toxicity of radiation therapy (RT) after radical prostatectomy (RP) for prostate cancer at Radiation Oncology Centres, Toowoomba.MethodsThe electronic medical records of 130 consecutive patients with histologically proven prostate adenocarcinoma who underwent post‐prostatectomy RT between January 2008 and December 2014 were analysed. Primary endpoint was Biochemical Recurrence (BCR) after RT. BCR was defined by PSA > 0.2 ng/mL and BCR endpoints were analysed using Kaplan–Meier methods. The impact of RT technique and the rates of acute and late toxicities are also reported. Toxicities were graded according to Radiation Therapy Oncology Group (RTOG) criteria.ResultsMedian follow‐up time after RT (regardless of technique) was 28 months. BCR occurred in 32 of the 126 patients (25%) whose prostate specific antigen (PSA) levels have been monitored post‐RT. At 24 and 36 months, 85% and 75% of patients were BCR‐free, respectively. Patients with a pre‐RT PSA above 0.2 ng/mL had a higher probability of recurrence than patients with values below 0.2 ng/mL (P = 0.03). RT technique, pelvic nodal irradiation, androgen deprivation therapy, T staging or surgical margin did not significantly impact BCR results.No patient experienced acute toxicities greater than grade 2. Grade 1 or 2 late gastrointestinal (GI) toxicity occurred in 11% and 1 patient experienced a grade 3 event. 12% of patients developed grade 1 or 2 late genitourinary (GU) toxicity, with evidence of grade 3 severity in only 1 patient. Evidence of a trend in reduction in late GI toxicity with the use of intensity modulated radiation therapy (IMRT) or volumetric modulated arc therapy (VMAT) was apparent but not with late GU toxicity.ConclusionAt our regional centre, early RT (PSA < 0.2 ng/mL) was associated with significant improvement in BCR‐free survival. Rates of toxicity mirror those of landmark trials which suggest no detriment for our regional prostate cancer patients. The use of IMRT/VMAT techniques was associated with a trend towards reduced rates of GI toxicity.

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“…Figure S1. On the basis of previously defined CAPRA-S risk categories, 15 6, 58 and 36% of men were classified as low (0-2), intermediate (3)(4)(5) and high risk (6-12), respectively and the cumulative incidence of metastasis at 10 years post RP was 11.3, 3.3 and 21.4%, respectively. In contrast, Decipher score classified 57, 27 and 16% as low (o0.45), intermediate (0.45-0.60) and high risk (40.60), respectively.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 Three randomized clinical trials in men with nonmetastatic PCa following surgical resection showed that treatment with adjuvant radiation therapy (ART) as compared with observation resulted in lower rates of biochemical recurrence, yet had conflicting impact on metastasis-free and overall survival. [3][4][5] Given the disparate findings, there has been an increase in utilization of salvage radiation therapy (SRT) 6 with concomitant decrease in ART, despite no randomized prospective trial evidence supporting this clinical decision. Although multiple randomized clinical trials are ongoing, 7,8 results are not expected for several years.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Postoperative Radiation in a Prostatectomy Cohort Adjusted for Clinical and Genomic Risk

Den

Yousefi

Trock

et al. 2016

International Journal of Radiation Oncology*Biology*Physics

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BACKGROUND: To date, there have been no published trials examining the impact of salvage radiation therapy (SRT) in the post-operative setting for prostate cancer (PCa). We conducted a retrospective, comparative study of post-operative radiation following radical prostatectomy (RP) for men with pT3 disease or positive margins (adverse pathological features, APF). METHODS: 422 PCa men treated at four institutions with RP and having APF were analyzed with a primary end point of metastasis. Adjuvant radiation treatment (ART, n = 111), minimal residual disease (MRD) SRT (n = 70) and SRT (n = 83) were defined by PSA levels of o 0.2, 0.2-0.49 and ⩾ 0.5 ng ml − 1 , respectively, before radiation therapy (RT) initiation. Remaining 157 men who did not receive additional therapy before metastasis formed the no RT arm. Clinical-genomic risk was assessed by Cancer of the Prostate Risk Assessment Post-Surgical (CAPRA-S) and Decipher. Cox regression was used to evaluate the impact of treatment on outcome. RESULTS: During the study follow-up, 37 men developed metastasis with a median follow-up of 8 years. Both CAPRA-S and Decipher had independent predictive value on multivariable analysis for metastasis (P o0.05). Adjusting for clinical-genomic risk, SRT and no RT had hazard ratios of 4.31 (95% confidence interval, 1.20-15.47) and 5.42 (95% confidence interval, 1.59-18.44) for metastasis compared with ART, respectively. No significant difference was observed between MRD-SRT and ART (P = 0.28). Men with low-to-intermediate CAPRA-S and low Decipher value have a low rate of metastatic events regardless of treatment selection. In contrast, men with high CAPRA-S and Decipher benefit from ART, however the cumulative incidence of metastasis remains high. CONCLUSIONS: The decision as to the timing and need for additional local therapy following RP is nuanced and requires providers and patients to balance risks of morbidity with improved oncological outcomes. Post-RP treatment can be safely avoided for men who are low risk by clinical-genomic risk, whereas those at high risk should favor enrollment in clinical trials. Prostate Cancer and Prostatic Diseases INTRODUCTIONAggressive treatment approaches that have not yet been shown to improve overall survival are controversial within oncology, particularly in the management of men with prostate cancer (PCa). 1,2 Three randomized clinical trials in men with nonmetastatic PCa following surgical resection showed that treatment with adjuvant radiation therapy (ART) as compared with observation resulted in lower rates of biochemical recurrence, yet had conflicting impact on metastasis-free and overall survival. [3][4][5] Given the disparate findings, there has been an increase in utilization of salvage radiation therapy (SRT) 6 with concomitant decrease in ART, despite no randomized prospective trial evidence supporting this clinical decision. Although multiple randomized clinical trials are ongoing, 7,8 results are not expected for several years. Thus, patients and physicians are left with mu...

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Adjuvant Radiotherapy Versus Wait-and-See After Radical Prostatectomy: 10-year Follow-up of the ARO 96–02/AUO AP 09/95 Trial

Cited by 398 publications

References 27 publications

EAU-ESTRO-SIOG Guidelines on Prostate Cancer. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent

EAU-ESTRO-SIOG Guidelines on Prostate Cancer. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent

Outcomes of post‐prostatectomy radiotherapy at a Regional Cancer Centre

Efficacy of Postoperative Radiation in a Prostatectomy Cohort Adjusted for Clinical and Genomic Risk

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