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Is Adjuvant Radiotherapy Beneficial After Radical Prostatectomy?

By: Kayci Reyer
Posted: Wednesday, December 23, 2020

According to research published in The Lancet, adjuvant radiotherapy for patients with high-risk prostate cancer who experience biochemical disease progression after radical prostatectomy may not result in a meaningful clinical benefit. And, adjuvant radiotherapy was found to increase the risk of urinary morbidity in this population.

“An observation policy with salvage radiotherapy for prostate-specific antigen biochemical progression should be the current standard after radical prostatectomy,” concluded Christopher C. Parker, MD, of the Royal Marsden NHS Foundation Trust, Sutton, UK, and colleagues.

The study included 1,396 patients who had undergone radical prostatectomy and who had at least one risk factor for biochemical disease progression. Between November 22, 2007, and December 30, 2016, patients were randomly assigned to receive either adjuvant radiotherapy (50%; n = 697) or salvage radiotherapy (50%; n = 699); the average age in each treatment group was 65 years. At a median follow-up of 4.9 years, 649 patients (93%) in the adjuvant group had experienced radiotherapy within 6 months of study enrollment, and 228 patients (33%) in the salvage group reported having undergone radiotherapy within 8 years of study initiation.

The adjuvant group recorded a 5-year biochemical progression-free survival rate of 85% versus 88% in the salvage group. At a follow-up of 5 years, the rate of patients who had not received nonprotocol hormone therapy was comparable between the groups (93% adjuvant vs. 92% salvage).

As for toxicity, among patients who self-reported urinary inconvenience, it was more severe for those receiving adjuvant radiotherapy at the 1-year mark than for those receiving salvage radiotherapy. A total of 6% of patients in the adjuvant group and 4% of patients in the salvage group experienced grade 3 or 4 urethral stricture within 2 years of treatment.

Disclosure: For full disclosures of the study authors, visit thelancet.com.



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