BACKGROUND: The role of adjuvant radiotherapy (ART) after radical prostatectomy (RP) on survival of patients with prostate cancer (PCa) is still controversial. OBJECTIVE: We tested the impact of ART on cancer-specific mortality (CSM) and overall mortality (OM) in PCa patients according to pathologic PCa features. DESIGN, SETTING, AND PARTICIPANTS: We evaluated 1049 PCa patients treated with RP and extended pelvic lymph node dissection alone or in combination with adjuvant treatments between 1998 and 2008. All patients had positive surgical margins and/or pT3/pT4 disease with or without positive lymph nodes. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Cox regression analyses tested the relationship between pathologic characteristics and CSM rates. Independent predictors of survival were used to develop a novel risk score based on the number of risk factors. Finally, Cox regression models tested the relationship between ART and survival according to the number of risk factors. RESULTS AND LIMITATIONS: On multivariable analyses, only pathologic Gleason score ≥ 8, pT3b/T4 stage, and presence of positive lymph nodes represented independent predictors of CSM (all p ≤ 0.02). The cumulative number of these pathologic findings was used to develop a risk score, which was 0, 1, 2, and 3 in 43.6%, 22.1%, 20.7%, and 13.6% of patients, respectively. In patients sharing more than two mentioned predictors of CSM (primarily having a risk score of 0 or 1), ART did not significantly improve survival (all p ≥ 0.4). Conversely, in patients with a risk score ≥ 2, ART was associated with lower CSM and OM rates (all p=0.006). The observational nature of the cohort represents a limitation of the study. CONCLUSIONS: ART significantly improved survival only in patients with at least two of the following pathologic features at RP: Gleason score ≥ 8, pT3/pT4 disease, and positive lymph nodes. These patients represent the ideal candidates for ART after RP.
BACKGROUND: The role of adjuvant radiotherapy (ART) after radical prostatectomy (RP) on survival of patients with prostate cancer (PCa) is still controversial. OBJECTIVE: We tested the impact of ART on cancer-specific mortality (CSM) and overall mortality (OM) in PCa patients according to pathologic PCa features. DESIGN, SETTING, AND PARTICIPANTS: We evaluated 1049 PCa patients treated with RP and extended pelvic lymph node dissection alone or in combination with adjuvant treatments between 1998 and 2008. All patients had positive surgical margins and/or pT3/pT4 disease with or without positive lymph nodes. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Cox regression analyses tested the relationship between pathologic characteristics and CSM rates. Independent predictors of survival were used to develop a novel risk score based on the number of risk factors. Finally, Cox regression models tested the relationship between ART and survival according to the number of risk factors. RESULTS AND LIMITATIONS: On multivariable analyses, only pathologic Gleason score ≥ 8, pT3b/T4 stage, and presence of positive lymph nodes represented independent predictors of CSM (all p ≤ 0.02). The cumulative number of these pathologic findings was used to develop a risk score, which was 0, 1, 2, and 3 in 43.6%, 22.1%, 20.7%, and 13.6% of patients, respectively. In patients sharing more than two mentioned predictors of CSM (primarily having a risk score of 0 or 1), ART did not significantly improve survival (all p ≥ 0.4). Conversely, in patients with a risk score ≥ 2, ART was associated with lower CSM and OM rates (all p=0.006). The observational nature of the cohort represents a limitation of the study. CONCLUSIONS: ART significantly improved survival only in patients with at least two of the following pathologic features at RP: Gleason score ≥ 8, pT3/pT4 disease, and positive lymph nodes. These patients represent the ideal candidates for ART after RP.
Authors: Joo Yong Lee; Ho Won Kang; Koon Ho Rha; Nam Hoon Cho; Young Deuk Choi; Sung Joon Hong; Kang Su Cho Journal: J Cancer Res Clin Oncol Date: 2015-12-12 Impact factor: 4.553
Authors: Michael A Liss; Salman Farshchi-Heydari; Zhengtao Qin; Sean A Hickey; David J Hall; Christopher J Kane; David R Vera Journal: J Nucl Med Date: 2014-07-14 Impact factor: 10.057
Authors: Nicola Fossati; Niccolò M Passoni; Marco Moschini; Giorgio Gandaglia; Alessandro Larcher; Massimo Freschi; Giorgio Guazzoni; Daniel D Sjoberg; Andrew J Vickers; Francesco Montorsi; Alberto Briganti Journal: BJU Int Date: 2015-06-10 Impact factor: 5.588
Authors: Michael A Liss; Sean P Stroup; Zhengtao Qin; Carl K Hoh; David J Hall; David R Vera; Christopher J Kane Journal: Urology Date: 2014-08-16 Impact factor: 2.649
Authors: Felix Preisser; Elio Mazzone; Sophie Knipper; Sebastiano Nazzani; Marco Bandini; Shahrokh F Shariat; Michele Marchioni; Zhe Tian; Fred Saad; Daniel Taussky; Alberto Briganti; Hartwig Huland; Markus Graefen; Derya Tilki; Pierre I Karakiewicz Journal: Can Urol Assoc J Date: 2019-11-29 Impact factor: 1.862