Reconsidering adjuvant versus salvage radiation therapy for prostate cancer in the genomics era.
We developed a decision analysis framework to simulate the clinical choice of early adjuvant versus delayed salvage radiation therapy after radical prostatectomy.



We designed a Markov decision analysis model to represent two alternative treatment approaches for prostate cancer after prostatectomy over a 10-year time horizon. The model contained individualized inputs including genomic classifier score. Sensitivity analyses were performed to evaluate model results.



Observation with delayed salvage radiation is preferred according to the base case, with greater average length and quality of life. However, adjuvant therapy is preferred over observation with salvage when genomics-based estimates of recurrence are high.



Model results were sensitive to genomics-based estimates of cancer recurrence and to nonprostate cancer mortality.
Department of Public Health Sciences, University of Virginia School of Medicine, VA, USA.
Jennifer M
JM
Lobo
Department of Public Health Sciences, University of Virginia School of Medicine, VA, USA.
George J
GJ
Stukenborg
Department of Radiation Oncology, University of Virginia School of Medicine, VA, USA.
Daniel M
DM
Trifiletti
Department of Radiation Oncology, University of Virginia School of Medicine, VA, USA.
Nirav
N
Patel
Department of Radiation Oncology, University of Virginia School of Medicine, VA, USA.
Timothy N
TN
Showalter
D023281:Genomics; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local; D017430:Prostate-Specific Antigen; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000601:surgery*; D011788:Quality of Life; D018714:Radiotherapy, Adjuvant; D016879:Salvage Therapy
D017430:Prostate-Specific Antigen
comparative effectiveness research; genomics; oncology