Long term outcomes between adjuvant radiotherapy and combined radiotherapy with hormonal treatment after radical prostatectomy in high risk prostate cancer
DOI:
https://doi.org/10.52786/isu.a.16Keywords:
Prostate cancer, locally advanced, high risk, adjuvant radiotherapy, combined treatment, hormonal treatmentAbstract
Objective: To determine the oncological outcome of adjuvant treatment between radiotherapy (RT) alone and combined radiotherapy with androgen deprivation therapy (ADT) in high risk prostate cancer patients after radical prostatectomy (RP).
Materials and Methods: All medical records of high risk-prostate cancer patients (including PSA > 20 ng/ml, pT3-pT4 or Gleason score 8-10) who underwent RP in Siriraj Hospital between 2000 and 2016 were retrospectively reviewed. Demographic data, pathological staging, types of adjuvant treatment, time to follow up and time to biochemical recurrence (BCR) were analyzed.
Results: Undetectable PSA after RP was achieved in 1009 out of 1221 high risk prostate cancer patients who had been followed up at least 6 months after surgery. Pathological staging pT2, pT3, pT4 and N1 was 23.8%, 73%, 0.8% and 4.7%, respectively. Forty one percent received adjuvant treatment (41 adjuvant RT alone, 74 combined adjuvant RT and ADT, 303 ADT alone). Median follow up time in the adjuvant RT group and combined treatment group was 63.8 months (8.9 - 210.7). BCR rates were 22% (9 of 41) for adjuvant RT and 12.2% (9 of 74) for adjuvant combined treatment. 10-year BCR-free survival in the two groups was 70.2% and 83.8%, respectively. There was no statistical difference between adjuvant RT and adjuvant combined treatment in terms of survival benefit (Hazard Ratio 0.40; p = 0.057).
Conclusion: Adjuvant radiotherapy after radical prostatectomy increases long term survival outcomes for high risk prostate cancer patients. This study shows that combined adjuvant RT and ADT may improve BCR-free survival.
References
Stephenson AJ, Bolla M, Briganti A, et al. Postoperative radiation therapy for pathologically advanced prostate cancer after radical prostatectomy. Eur Urol 2012;61:443-51.
Bolla M, van Poppel H, Tombal B, Vekemans K, Da Pozzo L, de Reijke TM, et al. Postoperative radiotherapy after radical prostatectomy for high-risk prostate cancer: long-term results of a randomised controlled trial (EORTC trial 22911). The Lancet 2012;380:2018-27.
Thompson IM, Tangen CM, Paradelo J, Lucia MS, Miller G, Troyer D, et al. Adjuvant radiotherapy for pathological T3N0M0 prostate cancer significantly reduces risk of metastases and improves survival: long-term follow up of a randomized clinical trial. J Urol 2009;181:956-62.
Wiegel T, Bartkowiak D, Bottke D, Bronner C, Steiner U, Siegmann A, et al. Adjuvant radiotherapy versus wait-and-see after radical prostatectomy: 10-year follow-up of the ARO 96-02/AUO AP 09/95 trial. Eur Urol 2014;66:243-50.
Woranisarakul V, Leewansangtong S, Dankulchai P, Apiwarodom N, Srinualnad S, Taweemonkongsap T, et al. Oncological Outcomes of Radiotherapy after Radical Prostatectomy in Thai Patients with Prostate Cancer. J Med Assoc Thai 2017;100:S179-85.
Boonyapanichskul P, Leewansangtong S, Srinualnad S, Nualyong C, Taweemonkongsap T, Woranisarakul V. Outcome of Adjuvant versus Salvage Androgen Deprivation Therapy (ADT) with/without Radiotherapy Following Radical Prostatectomy for Prostate Cancer Patients with Adverse Pathologic Feature(s) or with Positive Regional Lymph Node Metastasis. J Med Assoc Thai 2020;103:75-80.
Shipley WU, Seiferheld W, Lukka HR, Major PP, Heney NM, Grignon DJ, et al. Radiation with or without antiandrogen therapy in recurrent prostate cancer. N Engl J Med 2017;376:417-28.
Carrie C, Magne N, Burban-Provost P, Sargos P, Latorzeff I, Lagrange J, et al. Short-term androgen deprivation therapy combined with radiotherapy as salvage treatment after radical prostatectomy for prostate cancer (GETUG-AFU 16): a 112-month follow-up of a phase 3, randomised trial. Lancet Oncol 2019;20:1740-49.
Cookson MS, Aus G, Burnett AL, Canby-Hagino ED, D’Amico AV, Dmochoski RR, et al. Variation in the definition of biochemical recurrence in patients treated for localized prostate cancer: the American Urological Association Prostate Guidelines for Localized Prostate Cancer Update Panel report and recommendations for a standard in the reporting of surgical outcomes. J Urol 2007;177:540-5.
Bolla M, Van Tienhoven G, Warde P, Dubois JB, Mirimanoff R, Storme G, et al. External irradiation with or without long-term androgen suppression for prostate cancer with high metastatic risk: 10-year results of an EORTC randomised study. Lancet Oncol 2010;11:1066-73.
Pilepich MV, Winter K, Lawton CA, Krisch R, Wolkov HB, Movsas B, et al. Androgen suppression adjuvant to definitive radiotherapy in prostate carcinoma--long-term results of phase III RTOG 85-31. Int J Radiat Oncol Biol Phys 2005;61:1285-90.
Horwitz EM, Bae K, Hanks GE, Porter A, Grignon DJ, Brereton HD, et al. Ten-year follow-up of radiation therapy oncology group protocol 92-02: a phase III trial of the duration of elective androgen deprivation in locally advanced prostate cancer. J Clin Oncol 2008;26:2497-504.
Mohit G, Hiten D P, Zeyad R S, Tran PT, Partin AW. Adjuvant radiation with androgen-deprivation therapy for men with lymph node metastases after radical prostatectomy: identifying men who benefit. BJU Int 2019;123:252-60.
