Comparative outcomes between adjuvant and salvage radiotherapy in prostate cancer after minimally invasive radical prostatectomy

Abstract

Objective: Radical prostatectomy (RP) is the standard treatment in clinically localized prostate cancer. However, the timing of postoperative radiotherapy (RT) in patients with adverse pathologic features or PSA persistence remains controversial. The objective of this study is to compare the survival outcomes and treatment complications between adjuvant radiotherapy (aRT) and salvage radiotherapy (sRT) in patients after minimally invasive RP. Materials and Methods: This retrospective study reviewed the clinical data in patients who underwent minimally invasive RP in our institution between January 2012 and April 2021. The patients were divided into three groups: no RT, aRT, and sRT. Patient demographic data, pathological reports, RTOG/EORTC toxicity scores, functional outcomes, and survival outcomes were compared between aRT and sRT groups. Results: A total of 487 patients were included in the study. One-hundred and thirty-three patients (27.3%) received postoperative RT. The pathological stage and positive margin rate were significantly higher in the aRT group. Five-year ADT-free survival (78.8% vs 80%, p = 0.68), 5-year metastasis-free survival (80.2% vs 92.2%, p = 0.38), and 5-year overall survival (97.1% vs 100%, p = 0.68) were no different between groups. There were no significant differences in continence, potency, genitourinary or gastrointestinal toxicities between groups. Conclusions: Timing of postoperative RT does not affect survival. Functional outcomes and radiation toxicity were comparable between patients undergoing aRT and sRT.