title: A multi-institutional matched-control analysis of adjuvant and salvage postoperative radiation therapy for pT3-4N0 prostate cancer.
abstract: OBJECTIVE
  It is unclear whether postoperative salvage radiation therapy (SRT) and early adjuvant radiotherapy (ART) after radical prostatectomy lead to equivalent long-term tumor control. We studied a group of patients undergoing ART by comparing them with a matched control group undergoing SRT after biochemical failure.
  
  
  METHODS
  Using a multi-institutional database of 2299 patients, 449 patients with pT3-4N0 disease were eligible for inclusion, including 211 patients receiving ART and 238 patients receiving SRT. Patients were matched in a 1:1 ratio according to preoperative prostate-specific antigen Gleason score, seminal vesicle invasion, surgical margin status, and follow-up from date of surgery.
  
  
  RESULTS
  A total of 192 patients were matched (96:96). The median follow-up was 94 months from surgery and 73 months from RT completion. There was a significant reduction in biochemical failure with ART compared with SRT. The 5-year freedom from biochemical failure (FFBF) from surgery was 75% after ART, compared with 66% for SRT (hazard ratio [HR] = 1.6, P = .049). The 5-year FFBF from the end of RT was 73% after ART, compared with 50% after SRT (HR = 2.3, log rank [LR] P = .0007). From the end of RT, SRT and Gleason score >or=8 were independent predictors of diminished FFBF. From the date of surgery, Gleason score >or=8 was a significant predictor of FFBF.
  
  
  CONCLUSIONS
  Early ART for pT3-4N0 prostate cancer significantly reduces the risk of long-term biochemical progression after radical prostatectomy compared with SRT. Gleason score >or=8 was the only factor on multivariate analysis associated with metastasic progression.
authors.affiliation: Department of Urology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.
authors.forename: Edouard J
authors.initials: EJ
authors.lastname: Trabulsi
authors.forename: Richard K
authors.initials: RK
authors.lastname: Valicenti
authors.forename: Alexandra L
authors.initials: AL
authors.lastname: Hanlon
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Pisansky
authors.forename: Howard M
authors.initials: HM
authors.lastname: Sandler
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Kuban
authors.forename: Charles N
authors.initials: CN
authors.lastname: Catton
authors.forename: Jeff M
authors.initials: JM
authors.lastname: Michalski
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Zelefsky
authors.forename: Patrick A
authors.initials: PA
authors.lastname: Kupelian
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Lin
authors.forename: Mitchell S
authors.initials: MS
authors.lastname: Anscher
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Slawin
authors.forename: Claus G
authors.initials: CG
authors.lastname: Roehrborn
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Forman
authors.forename: Stanley L
authors.initials: SL
authors.lastname: Liauw
authors.forename: Larry L
authors.initials: LL
authors.lastname: Kestin
authors.forename: Theodore L
authors.initials: TL
authors.lastname: DeWeese
authors.forename: Peter T
authors.initials: PT
authors.lastname: Scardino
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Stephenson
authors.forename: Alan
authors.initials: A
authors.lastname: Pollack
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011184:Postoperative Period; D016016:Proportional Hazards Models; D011471:Prostatic Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D011878:Radiotherapy / Q000379:methods*; D016879:Salvage Therapy / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome