A multi-institutional matched-control analysis of adjuvant and salvage postoperative radiation therapy for pT3-4N0 prostate cancer.
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.
Trabulsi
Edouard J
EJ
Department of Urology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.
Valicenti
Richard K
RK
Hanlon
Alexandra L
AL
Pisansky
Thomas M
TM
Sandler
Howard M
HM
Kuban
Deborah A
DA
Catton
Charles N
CN
Michalski
Jeff M
JM
Zelefsky
Michael J
MJ
Kupelian
Patrick A
PA
Lin
Daniel W
DW
Anscher
Mitchell S
MS
Slawin
Kevin M
KM
Roehrborn
Claus G
CG
Forman
Jeffrey D
JD
Liauw
Stanley L
SL
Kestin
Larry L
LL
DeWeese
Theodore L
TL
Scardino
Peter T
PT
Stephenson
Andrew J
AJ
Pollack
Alan
A
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