Postprostatectomy Radiation Therapy

Table 1.  Randomized trials of adjuvant radiation versus observation following radical prostatectomy for men with adverse pathologic features.

Study	Number		Randomization	RT technique	bPFS (%)	p-value	OS (%)	p-value	Ref.
	Total	Randomized
SWOG 8794	425	211	Observation	2D	36 (10 years)	<0.001	48 (12.5 years)	0.023	[6]
		214	60–64 Gy		65 (10 years)		59 (12.5 years)
EORTC 22911	1005	503	Observation	2D	41 (10 years)	<0.001	77 (10 years)	>0.1	[11]
		502	60 Gy		61 (10 years)		81 (10 years)
ARO 96–02	307†	159	Observation	3D	54 (5 years)	0.0015	NR		[7]
		148	60 Gy		72 (5 years)		NR

^†Patients with detectable prostate-specific antigen at randomization (n = 78) excluded from intention-to-treat analysis.
ARO: Arbeitsgemeinschaft Radiologische Onkologie; bPFS: Biochemical progression-free survival; EORTC: European Organization for Research and Treatment of Cancer; NR: Not reported; OS: Overall survival; RT: Radiation treatment; SWOG: Southwest Oncology Group.

Authors and Disclosures

Mark V Mishra¹, Colin E Champ¹, Robert B Den¹, Eli D Scher², Xinglei Shen¹, Edouard J Trabulsi³, Costas D Lallas³, Karen E Knudsen^3,4, Adam P Dicker¹ & Timothy N Showalter*<sup>1

1</sup>Department of Radiation Oncology, Kimmel Cancer Center, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA, USA
²University of Medicine & Dentistry of New Jersey, Robert Wood Johnson School of Osteopathic Medicine, New Brunswick, NJ, USA
³Department of Urology, Thomas Jefferson University, Philadelphia, PA, USA
⁴Department of Cancer Biology, Kimmel Cancer Center, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA, USA

*Author for correspondence
Thomas Jefferson University, Bodine Center for Cancer Treatment, 111 S. 11th Street, Philadelphia, PA 19107, USA Tel.: +1 215 955 6702 Fax: +1 215 955 0412 timothy.showalter@jeffersonhospital.org

Sidebar

Executive Summary

Current Evidence

• Patients with adverse pathological features (APFs) are at high risk for developing a biochemical recurrence following radical prostatectomy.

• Three Phase III trials have demonstrated biochemical progression-free survival advantage in favor of immediate adjuvant radiation therapy (ART) and one has even demonstrated an overall survival advantage.

• Controversy exists as to whether close observation followed by early salvage radiation therapy at the time of a biochemical recurrence can be equivalent to ART and two Phase III trials are currently underway to compare the two treatment approaches.

• Modern radiotherapy techniques allow for significant normal tissue sparing, resulting in very low rates of high-grade toxicity and minimal changes in patient health-related quality-of-life factors.

Cost–effectiveness

• For every two patients with APFs treated with ART, one biochemical failure will be prevented.

• For every nine patients with APFs treated with ART, one death will be prevented.

• The estimated cost per additional prostate-specific antigen success achieved at 10 years with ART is estimated to be <US$27,000.

Future Research

• Ongoing trials will establish the role of androgen deprivation therapy and pelvic nodal irradiation.

• Hypofractionated radiotherapy is an emerging field that may allow for improved tumor control and/or decreased normal tissue toxicity.

• Efforts to identify novel biomarkers to determine which postprostatectomy patients are at high risk for failure are currently underway.