663 ADJUVANT VERSUS SALVAGE RADIATION THERAPY FOR PROSTATE CANCER AND THE RISK OF DEATH (2010)

You have accessJournal of UrologyProstate Cancer: Advanced II1 Apr 2010663 ADJUVANT VERSUS SALVAGE RADIATION THERAPY FOR PROSTATE CANCER AND THE RISK OF DEATH Anthony D'Amico, Ming-Hui Chen, Leon Sun, W. Robert Lee, Vladimir Mouraviev, Cary Robertson, Philip Walther, Thomas Polascik, David Albala, and Judd Moul Anthony D'AmicoAnthony D'Amico Boston, MA More articles by this author , Ming-Hui ChenMing-Hui Chen Storrs, CT More articles by this author , Leon SunLeon Sun Durham, NC More articles by this author , W. Robert LeeW. Robert Lee Durham, NC More articles by this author , Vladimir MouravievVladimir Mouraviev Durham, NC More articles by this author , Cary RobertsonCary Robertson Durham, NC More articles by this author , Philip WaltherPhilip Walther Durham, NC More articles by this author , Thomas PolascikThomas Polascik Durham, NC More articles by this author , David AlbalaDavid Albala Durham, NC More articles by this author , and Judd MoulJudd Moul Durham, NC More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1050AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Adjuvant radiation therapy (RT) for men with positive margins (R1), extracapsular or seminal vesicle extension (pT3) decreases the risk of all cause mortality (ACM). Whether salvage RT for PSA failure can provide the same result as adjuvant was investigated. METHODS We studied 1638 men at Duke University who underwent radical prostatectomy for unfavorable-risk prostate cancer and who's postoperative PSA was undetectable. Cox regression was used to evaluate whether salvage versus adjuvant RT in men with a rapid (< 10 months) or slow (at least 10 months) PSA doubling time (DT) was associated with the risk of ACM adjusting for adverse features (pT3, R1, pGleason score 8 to 10), age, preoperative PSA level, comorbidity and hormonal therapy use. RESULTS Despite less men with at least 2 adverse features (61% versus 82%; p = 0.016), salvage for a rapid PSADT versus adjuvant RT increased the risk of ACM (Adjusted Hazard Ratio (AHR): 3.42, 95% Confidence Interval (CI): [1.27 to 9.20]; p = 0.015). There was no difference (AHR: 1.39, 95% CI: [0.50 to 3.90]; p = 0.53) in the risk of ACM among men who received salvage for a slow PSADT or adjuvant RT. Nearly all (90%) men with a slow PSA DT had pGleason score 7 or less and the majority (59%) had at most pT3 or R1 disease. CONCLUSIONS Only in men with pGleason score 7 or less and pT3R0 or pT2R1 disease, RT following PSA failure was not associated with an increased risk of ACM when compared to adjuvant RT Clinical Characteristic Number of Observed Men Number of Observed Events Multivariable Analysis Adjusted HR 95% CI p-value Adjuvant RT 65 6 1.0(Ref) - Salvage RT (t) and slow PSA DT 49 10 1.39(0.50,3.90) 0.532 Salvage RT (t) and rapid PSA DT 46 13 3.42(1.27,9.20) 0.015 No RT (t) 1478 185 2.49(1.07,5.76) 0.034 No HT (t) 1538 191 1.0(Ref) - Adjuvant HT 18 1 0.72(0.10,5.24) 0.103 Salvage HT (t) for initial PSA failure 14 1 0.15(0.02,1.12) 0.064 Salvage HT (t) following Salvage RT 68 21 0.79(0.49,1.29) 0.347 Preoperative PSA level in ng/ml 1638 214 0.94(0.77,1.15) 0.554 pGleason score 6 or less 275 54 1.0(Ref) - 7 1154 123 1.46(1.03,2.07) 0.033 8 116 17 1.80(1.01,3.20) 0.046 9 or 10 93 20 2.40(1.40,4.14) 0.002 Age in years at RP 1638 214 1.03(1.01,1.05) 0.007 Prostatectomy Stage pT2 1441 177 1.0(Ref) - pT3 197 37 1.26(0.91,1.76) 0.170 Margin Status Negative 881 110 1.0(Ref) - Positive 757 104 1.28(0.97,1.69) 0.087 No Comorbidity (t) 817 131 1.0(Ref) - Comorbidity Present at Baseline 577 27 2.02(1.28,3.18) 0.002 Comorbidity acquired (t) following RP 244 56 1.31(0.95,1.81) 0.097 (t) Signifies a time dependent covariate © 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e259 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Anthony D'Amico Boston, MA More articles by this author Ming-Hui Chen Storrs, CT More articles by this author Leon Sun Durham, NC More articles by this author W. Robert Lee Durham, NC More articles by this author Vladimir Mouraviev Durham, NC More articles by this author Cary Robertson Durham, NC More articles by this author Philip Walther Durham, NC More articles by this author Thomas Polascik Durham, NC More articles by this author David Albala Durham, NC More articles by this author Judd Moul Durham, NC More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...