Adjuvant radiotherapy after radical prostatectomy shows no ability to improve rates of overall and cancer-specific survival in a matched case-control study.
OBJECTIVE
To assess the effect of adjuvant radiotherapy (aRT) on the rate of cancer-specific and overall survival after radical prostatectomy (RP) in a group of patients with a long-term follow-up, as there is controversy about the benefit of aRT after RP for prostate cancer when endpoints beyond biochemical and local recurrence are considered.


METHODS
Within a study cohort of 752 patients treated with RP, 118 (15.7%) received aRT; these patients were matched with controls who did not receive aRT after RP. Exact matches were made for pT stage, RP Gleason sum, surgical margin status, age (+/-10 years), year of surgery (+/-10 years) and delivery of hormonal therapy. Kaplan-Meier and life-table analyses were used to assess overall and cancer-specific survival


RESULTS
The median (range) follow-up was 11.4 (0.1-41) years. The 10- and 20-year overall survival after RP in those with no aRT were, respectively, 81.1% and 44.8%, vs 75.5% and 40.0% in the aRT group (P = 0.1). The corresponding probabilities for cause-specific survival were, respectively, 97.3% and 89.0% vs 86.3% and 69.3% (P < 0.001). There was no statistically significant difference in the overall and cause-specific survival between the groups after matching (hazard ratio 0.9, log rank P = 0.6; and 2.1, log rank P = 0.1, respectively).


CONCLUSIONS
Our analysis showed that, in a matched case-control study, aRT has no effect on overall and cancer-specific survival. Further randomized long-term studies are necessary to confirm these results.
Porter
Christopher R
CR
Department of Urology, Virginia Mason Medical Center, Seattle, WA, USA.
Capitanio
Umberto
U
Perrotte
Paul
P
Walz
Jochen
J
Isbarn
Hendrik
H
Kodama
Koichi
K
Gibbons
Robert P
RP
Correa
Roy
R
Karakiewicz
Pierre I
PI
D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D015331:Cohort Studies; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D018714:Radiotherapy, Adjuvant; D016032:Randomized Controlled Trials as Topic; D016019:Survival Analysis; D016896:Treatment Outcome