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Adjuvant radiotherapy appears to reduce risk of progression in advanced prostate cancer

Thursday, July 02 2009 | Comments

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What's This? In patients with pT3 prostate cancer, adjuvant radiotherapy following radical prostatectomy (RP) significantly reduces the risk of biochemical progression compared with RP alone, according to recently published study results.

Although previous trials have demonstrated a benefit of adjuvant radiotherapy following RP, none of these trials was prospectively designed to show if patients with undetectable prostate-specific antigen (PSA) after RP would benefit from such therapy, the authors explained.

This prospective Phase III trial included 385 men with pT3 (extending beyond the capsule), node-negative tumors who underwent RP. Of these men, 307 had undetectable PSA following surgery and were randomized to receive immediate radiotherapy or to be managed with a "wait-and-see" approach. Biochemical progression-free survival was the primary endpoint (biochemical no evidence of disease [bNED]).

The addition of radiotherapy significantly increased biochemical progression-free survival after an overall median follow-up of 53.7 months, compared with a wait-and-see approach (72% vs 54%; hazard ratio, 0.53; 95% CI, 0.37-0.79; P=.0015).

Multivariate analysis identified several factors that were independent predictors of biochemical outcome, including a preoperative PSA level of more than 10 ng/mL, radiotherapy, and a tumor stage of pT3a/b versus a stage of pT3c.

"[O]ur study supports formerly reported results and gives evidence of an 18% benefit of bNED at 5 years after adjuvant radiotherapy for pT3 tumors with or without positive margins, even with an undetectable PSA after RP," the authors concluded. "Longer follow-up is needed to clarify the impact of adjuvant radiotherapy on metastases-free survival and overall survival." (Wiegel T, et al. J Clin Oncol 2009;27:2924-2930.)

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