Postoperative radiotherapy in prostate cancer: Analysis of prognostic factors in a series of 282 patients

Abstract

AimTo assess the outcomes of patients treated with postoperative RT in relation to the possible prognostic factors. BackgroundPostoperative radiotherapy (RT) has been proved to reduce the risk of biochemical recurrence in high-risk prostate cancer patients. Baseline prostate specific antigen (PSA), pathological Gleason score (GS), positive surgical margins, nodal status and seminal vesicle invasion are independent predictors of biochemical relapse. Materials and methodsThe clinical records of 282 patients who underwent postoperative RT were retrospectively reviewed. The prognostic value of postoperative PSA, preoperative risk class, nodal status, pathological GS, margins status, and administration of hormonal therapy (HT) was analyzed. ResultsPostoperative RT was delivered with a median dose to the prostatic fossa of 66Gy (range 50–72) in 1.8–2Gy/fraction. Median follow-up was 23.1 months (range 6–119). Five-year actuarial biochemical disease-free survival (bDFS) and overall survival rates were 76% and 95%, respectively. Higher bDFS was found for patients with postoperative PSA <0.02ng/ml (p=0.03), low preoperative risk class (p=0.01), pN0 (p=0.003), GS 4–6 (p=0.0006), no androgen deprivation therapy (p=0.02), and irrespective of surgical margin status (p=0.10). Multivariate analysis showed that postoperative PSA and Gleason score had a significant impact on bDFS (p=0.039 and p=0.05, respectively). ConclusionsPostoperative RT with a dose of 66Gy offers an acceptable toxicity and an optimal disease control after radical prostatectomy in patients with different risk features. A postoperative PSA >0.02ng/ml could be considered as a prognostic factor and a tool to select patients at risk for progression.