Radiotherapy after radical prostatectomy: treatment recommendations differ between urologists and radiation oncologists.
OBJECTIVE
There is no consensus on optimal use of radiotherapy following radical prostatectomy. The purpose of this study was to describe opinions of urologists and radiation oncologists regarding adjuvant and salvage radiotherapy following radical prostatectomy.


METHODS
Urologists and genitourinary radiation oncologists were solicited to participate in an online survey. Respondent characteristics included demographics, training, practice setting, patient volume/experience, and access to radiotherapy. Participant practice patterns and attitudes towards use of adjuvant and salvage radiotherapy in standardized clinical scenarios were assessed.


RESULTS
One hundred and forty-six staff physicians participated in the survey (104 urologists and 42 genitourinary radiation oncologists). Overall, high Gleason score (Gleason 7 vs. 6, RR 1.37 95% CI 1.19-1.56, p<0.0001 and Gleason 8-10 vs. 6, RR 1.56 95% CI 1.37-1.78, p<0.0001), positive surgical margin (RR 1.43 95% CI 1.26-1.62, p<0.0001), and extraprostatic tumour extension (RR 1.16 95% CI 1.05-1.28, p<0.002) conferred an increased probability of recommending adjuvant radiotherapy. Radiation oncologists were more likely to recommend adjuvant radiotherapy across all clinical scenarios (RR 1.48, 95% CI 1.39, 1.60, p <0.001). Major differences were found for patients with Gleason 6 and isolated positive surgical margin (radiotherapy selected by 21% of urologists vs. 70% of radiation oncologists), and patients with extraprostatic extension and negative surgical margins (radiotherapy selected by 18% of urologist vs. 57% of radiation oncologists).


CONCLUSIONS
Urologists and radiation oncologists frequently disagree about recommendation for post-prostatectomy adjuvant radiotherapy. Since clinical equipoise exists between adjuvant versus early salvage post-operative radiotherapy, support of clinical trials comparing these approaches is strongly encouraged.
Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.
Luke T
LT
Lavallée
Dean
D
Fergusson
Ranjeeta
R
Mallick
Renée
R
Grenon
Scott C
SC
Morgan
Franco
F
Momoli
Kelsey
K
Witiuk
Chris
C
Morash
Ilias
I
Cagiannos
Rodney H
RH
Breau
D003625:Data Collection; D005104:Expert Testimony; D006801:Humans; D008297:Male; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D018787:Radiation Oncology; D018714:Radiotherapy, Adjuvant / Q000706:statistics & numerical data*; D016879:Salvage Therapy / Q000706:statistics & numerical data*; D014572:Urology
D017430:Prostate-Specific Antigen