Adjuvant Superior to Salvage Radiotherapy Post-RP

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VIENNA—Adjuvant radiotherapy following radical prostatectomy (RP) for locally advanced prostate cancer (PCa) is associated with better outcomes than early salvage radiotherapy, according to a study.

Alberto Briganti, MD, of the Urological Research Institute, Vita-Salute San Raffaele University, Milan, Italy, and collaborators studied 420 patients with advanced PCa (pT2-4 R0-R1 pN0) who underwent radical prostatectomy (RP) at three tertiary care centers. Of these, 313 with undetectable PSA after surgery had immediate adjuvant radiotherapy (aRT) and 107 had early salvage radiotherapy (eSRT), meaning the patients received radiotherapy if they had a PSA value below 0.5 ng/mL.

Overall, the mean follow-up was 78.5 months (range 4.8-188 months). A total of 143 of the 313 aRT patients were matched with 89 of the 107 patients who received eSRT when their PSA was below 0.5. After matching, the two groups had similar clinical and pathologic characteristics.

The five- and eight-year biochemical recurrence (BCR)-free survival rates were 82.3% and 72.8% in the aRT group, respectively, compared with 65.5% and 45.9% in the eSRT group, Dr. Briganti reported at the 26th Annual Meeting of the European Association of Urology.

Investigators observed similar results when they set the post-RP PSA definition of eSRT at 0.3. The five- and eight-year BCR-free survival rates were 78.4% and 70.7% in the aRT group versus 63.9% and 44.2% in the eSRT group.

In addition, aRT was associated with higher BCR-free survival rates when the researchers restricted analyses to those patients receiving higher radiation doses (66 Gy or higher).

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