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| |  Immediate Adjuvant Radiotherapy Prevents Relapse in Patients With High-Risk Prostate Cancer: Presented at EMUC By Chris Berrie BARCELONA, Spain -- December 1, 2009 -- Adjuvant radiotherapy (ART) provides significant improvements in biochemical outcome over salvage radiotherapy (SRT) in patients with prostate cancer with a high risk of disease recurrence (pT3-4N0), according to a matched-control analysis presented here on November 28 at the 2nd European Multidisciplinary Meeting on Urological Cancers (EMUC). As principal investigator Gert De Meerleer, MD, PhD, Ghent University Hospital, Ghent, Belgium, noted initially, “All patients have been treated with intensity-modulated radiotherapy, which has enabled us to give much higher doses than traditionally given in adjuvant postoperative or salvage postoperative settings.” Thus, the aim was to determine the appropriate timing of this postoperative intensity-modulated radiotherapy after radical prostatectomy for patients with high risk of disease recurrence. The full patient population included 298 patients: 133 treated with ART (74 Gy) and 165 with SRT (76 Gy). Patients were matched in a 1:1 ratio according to preoperative prostate-specific antigen (PSA) levels (<10 or >=10 ng/mL), Gleason score (<4+3 or >=4+3), and pathological T stage (pT) of pT3a, pT3b, or pT4, without or with 6-month androgen deprivation. The matching criteria of only pT3-4N0 patients allowed inclusion of 198 of these; all matching was blinded to patient outcome. For this analysis, 112 patients were matched. The median follow-up was 34 months from radiotherapy completion for the whole group. Baseline characteristics across the ART and SRT treatment groups did not differ significantly for median age, median follow-up, PSA at referral, Gleason score, tumour stage, androgen deprivation, and perineural invasion. However, significant differences were seen for positive margins (ART, 72% vs SRT, 52%; P < .05) and PSA <1 ng/mL at start of radiotherapy (ART, 98% vs SRT, 62%; P < .05). The investigators found a significant reduction in 3-year biochemical failure for ART, compared with SRT: 91% versus 59% (P = .004). There was no significant difference in biochemical relapse-free survival (RFS) for ART and SRT when pre-radiotherapy PSA levels were <1 ng/mL (91% vs 75%), suggesting SRT may be effective in this scenario. PSA >10 ng/mL at diagnosis, PSA >1 ng/mL before start of radiotherapy, and negative surgical margins predicted a reduced biochemical RFS in the SRT group. On multivariate analysis, ART, Gleason score <4+3, and preoperative PSA <10 ng/mL were significantly correlated with better biochemical RFS. Thus, while noting that “within the urology community there is still some reluctance to send patients immediately after surgery for adjuvant radiotherapy, and [physicians] wait until the PSA goes up,” Professor Meerleer stressed that waiting and performing SRT later leads to significantly worse results for the patient compared with implementing immediate ART. EMUC was co-organised by the European Association of Urology (EAU), the European Society for Medical Oncology (ESMO), and the European Society for Therapeutic Radiology and Oncology (ESTRO). [Presentation title: A Matched-Control Analysis of Adjuvant and Salvage Postoperative Intensity-Modulated Radiotherapy for pT3-4N0 Prostate Cancer. Abstract P035]
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