MP14-08 LONG-TERM IMPACT OF ADJUVANT VERSUS EARLY SALVAGE RADIATION THERAPY ON CLINICAL RECURRENCE IN PT3N0 PROSTATE CANCER PATIENTS TREATED WITH RADICAL PROSTATECTOMY: RESULTS OF A MULTI-INSTITUTIONAL ANALYSIS (2016)

You have accessJournal of UrologyProstate Cancer: Localized: Radiation Therapy1 Apr 2016MP14-08 LONG-TERM IMPACT OF ADJUVANT VERSUS EARLY SALVAGE RADIATION THERAPY ON CLINICAL RECURRENCE IN PT3N0 PROSTATE CANCER PATIENTS TREATED WITH RADICAL PROSTATECTOMY: RESULTS OF A MULTI-INSTITUTIONAL ANALYSIS Nicola Fossati, Jeffrey R. Karnes, Alessandro Morlacco, Marco Moschini, Stephen A. Boorjian, Thomas Seisen, Alberto Bossi, Cesare Cozzarini, Claudio Fiorino, Barbara Noris Chiorda, Giorgio Gandaglia, Lorenzo Tosco, Dirk De Ridder, Steven Joniau, Gregor Goldner, Shahrokh François Shariat, Wolfgang Hinkelbein, Karin Haustermans, Bertrand Tombal, Francesco Montorsi, Hein Van Poppel, Thomas Wiegel, and Alberto Briganti Nicola FossatiNicola Fossati More articles by this author , Jeffrey R. KarnesJeffrey R. Karnes More articles by this author , Alessandro MorlaccoAlessandro Morlacco More articles by this author , Marco MoschiniMarco Moschini More articles by this author , Stephen A. BoorjianStephen A. Boorjian More articles by this author , Thomas SeisenThomas Seisen More articles by this author , Alberto BossiAlberto Bossi More articles by this author , Cesare CozzariniCesare Cozzarini More articles by this author , Claudio FiorinoClaudio Fiorino More articles by this author , Barbara Noris ChiordaBarbara Noris Chiorda More articles by this author , Giorgio GandagliaGiorgio Gandaglia More articles by this author , Lorenzo ToscoLorenzo Tosco More articles by this author , Dirk De RidderDirk De Ridder More articles by this author , Steven JoniauSteven Joniau More articles by this author , Gregor GoldnerGregor Goldner More articles by this author , Shahrokh François ShariatShahrokh François Shariat More articles by this author , Wolfgang HinkelbeinWolfgang Hinkelbein More articles by this author , Karin HaustermansKarin Haustermans More articles by this author , Bertrand TombalBertrand Tombal More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , Hein Van PoppelHein Van Poppel More articles by this author , Thomas WiegelThomas Wiegel More articles by this author , and Alberto BrigantiAlberto Briganti More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2511AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Three prospective randomised trials showed discordant results regarding the impact of adjuvant radiation therapy (aRT) relative to observation for metastasis-free and overall survival. Additionally, none of these trials systematically included patients who underwent early salvage radiation therapy (eSRT). We hypothesized that eSRT may be associated with similar cancer control rates compared to aRT METHODS Using a multi-institutional cohort from 7 tertiary referral centers, we identified 596 pT3N0 patients with undetectable PSA after radical prostatectomy (RP). Patients were stratified into two groups: aRT (Group 1) versus initial observation followed by eSRT in case of PSA relapse (Group 2). Specifically, aRT was administered within 6 months after RP, while eSRT was administered at a PSA level ≤0.5 ng/ml. The evaluated outcome was metastasis-free survival. Multivariable Cox regression analyses tested the association between groups (aRT vs observation ± eSRT) and distant metastasis. Covariates consisted of pathologic stage (pT3a vs ≥pT3b), pathologic Gleason score (≤6 vs 7 vs ≥8), and surgical margin status (negative vs positive). The rate of distant metastasis was plotted against baseline risk of metastasis (derived from the multivariable model) using st-lowess method RESULTS Overall, 242 (40%) and 354 (60%) patients underwent aRT and initial observation, respectively. Within the latter group, 141 (40%) patients experienced PSA relapse and underwent eSRT. Median follow-up (inter-quartile range) was similar among group 1 and 2: 94 (52, 127) and 91 (62, 124) months, respectively (p=0.4). Metastasis-free survival at 10 years was similar between groups: 89% (95% CI: 82%, 93%) vs 90% (95% CI: 82%, 95%), p=0.4. This result was confirmed at multivariable analysis (HR: 1.51; 95% CI: 0.68, 3.34; p=0.3). A comparable proportion of distant metastasis at 10 years among groups was observed, regardless or prostate cancer features (Figure 1) CONCLUSIONS At long-term follow-up, timely administration of eSRT showed comparable metastasis-free survival to aRT. Therefore, eSRT may not compromise cancer control, while significantly reducing potential over-treatment associated with aRT © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e146 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Nicola Fossati More articles by this author Jeffrey R. Karnes More articles by this author Alessandro Morlacco More articles by this author Marco Moschini More articles by this author Stephen A. Boorjian More articles by this author Thomas Seisen More articles by this author Alberto Bossi More articles by this author Cesare Cozzarini More articles by this author Claudio Fiorino More articles by this author Barbara Noris Chiorda More articles by this author Giorgio Gandaglia More articles by this author Lorenzo Tosco More articles by this author Dirk De Ridder More articles by this author Steven Joniau More articles by this author Gregor Goldner More articles by this author Shahrokh François Shariat More articles by this author Wolfgang Hinkelbein More articles by this author Karin Haustermans More articles by this author Bertrand Tombal More articles by this author Francesco Montorsi More articles by this author Hein Van Poppel More articles by this author Thomas Wiegel More articles by this author Alberto Briganti More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...