Abstract
PurposeTo retrospectively evaluate the biochemical no evidence of disease (bNED) and late side effects after adjuvant radiotherapy in prostate cancer patients.MethodsPatients (n = 85) treated with external beam radiotherapy between 1997 and 2013 following radical prostatectomy (RPE) with pathological tumour stage pT2c with positive surgical margins or pT3 and pT4 tumours with or without positive margins who presented with a postoperative and a preradiation prostate-specific antigen (PSA) level below 0.1 ng/ml. The mean dose applied was 66 Gy with conventional fractionation (4 field box-technique). No androgen deprivation therapy was administered, and patients with incomplete data (missing Gleason score, pT stage, or PSA values postoperatively and/or prior to radiation at the presentation at our department) have been excluded from the analysis. Biochemical recurrence was defined as reaching a PSA level > 0.2 ng/ml during follow-up and bNED rates were assessed. In addition, patients were divided into two groups according to the Roach formula for predicting the risk of pelvic node involvement at a cut-off value of 15%. Late urogenital and gastrointestinal side effects (EORTC/RTOG) were assessed.ResultsAfter a median follow-up of 60 months the bNED rate was 88% at 5 years and 72% at 10 years for all patients. Patients with low risk of lymph node involvement (group < 15%) had a 5 year and 10 year bNED of 97% and 85%, while patients with high risk of positive lymph node involvement (group > 15%) showed corresponding bNED rates of 77% and 52%, respectively. A significant difference according to the Roach stratification was detected (p ≤ 0.002). Late urogenital (UG) and gastrointestinal (GI) grade ≥ 2 side effects were detected in 10% and 15%, respectively.ConclusionPostoperative radiotherapy with an average dose of 66 Gy to the prostatic fossa following RPE provides excellent tumour control rates with acceptable side effects. Patients with a higher risk of positive lymph nodes (> 15%) according to the Roach formula show significant worse tumour control rates.
Highlights
Radical prostatectomy and primary radiotherapy are both efficient treatment options for primary localized prostate cancer with a high potential of curation
One group was defined by patients with a risk stratification for pelvic node involvement < 15% using the Roach formula, whereas the other group is defined as patients with a risk for pelvic node involvement > 15%
From the remaining 91 patients, 6 more were excluded for having a prostate-specific antigen (PSA) value postoperatively or prior to radiation between 0.1–0.2 ng/ml, in order to comply with the current definition of Adjuvant radiation (ART), resulting to a cohort of 85 patients
Summary
Radical prostatectomy and primary radiotherapy are both efficient treatment options for primary localized prostate cancer with a high potential of curation. About 30% of patients develop biochemical recurrence after radical prostatectomy (RPE) [1, 2]. Adjuvant radiation (ART) to the prostatic fossa following radical prostatectomy has shown to provide improved local control and biochemical control for patients with pT3 tumours and or positive A recently published Finnish trial applied a dose of 66 Gy and reported a bNED rate of 90% after 5 years [6]
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