You have accessJournal of UrologyProstate Cancer: Localized: Radiation Therapy1 Apr 2016MP14-12 EFFICACY OF EARLY AND DELAYED RADIATION IN A PROSTATECTOMY COHORT ADJUSTED FOR GENOMIC AND CLINICAL RISK Ashley Ross, Robert Den, Kasra Yousefi, Bruce Trock, Elai Davicioni, Jeffrey Tosoian, Darby Thompson, Voleak Choeurng, Zaid Haddad, Phuoc Tran, Edouard Trabulsi, Leonard Gomella, Costas Lallas, Firas Abdollah, Felix Feng, Adam Dicker, Stephen Freedland, Jeffrey Karnes, and Edward Schaeffer Ashley RossAshley Ross More articles by this author , Robert DenRobert Den More articles by this author , Kasra YousefiKasra Yousefi More articles by this author , Bruce TrockBruce Trock More articles by this author , Elai DavicioniElai Davicioni More articles by this author , Jeffrey TosoianJeffrey Tosoian More articles by this author , Darby ThompsonDarby Thompson More articles by this author , Voleak ChoeurngVoleak Choeurng More articles by this author , Zaid HaddadZaid Haddad More articles by this author , Phuoc TranPhuoc Tran More articles by this author , Edouard TrabulsiEdouard Trabulsi More articles by this author , Leonard GomellaLeonard Gomella More articles by this author , Costas LallasCostas Lallas More articles by this author , Firas AbdollahFiras Abdollah More articles by this author , Felix FengFelix Feng More articles by this author , Adam DickerAdam Dicker More articles by this author , Stephen FreedlandStephen Freedland More articles by this author , Jeffrey KarnesJeffrey Karnes More articles by this author , and Edward SchaefferEdward Schaeffer More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2515AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES In 3 published randomized clinical trials, adjuvant radiation therapy (ART) for prostate cancer (PCa) resulted in improved progression free survival. However, the impact on metastases and overall survival is unclear. To date, there have been no published prospective trials examining the impact of salvage radiation therapy (SRT) in this disease state. Hence, we conducted a retrospective, nonrandomized comparative study of adjuvant, salvage, or no radiation following radical prostatectomy (RP) for men with pT3 disease or positive margins (adverse pathologic features, APF). METHODS 422 PCa patients treated at four institutions with RP and having APF were analyzed with a primary end point of clinical metastasis. Men undergoing ART (n=111), early SRT (n=70) and delayed SRT (n=83) were defined by having prostate specific antigen (PSA) levels of <0.2, 0.2 to 0.5, and ≥0.5 ng/mL, respectively, prior to initiation of radiation therapy (RT). Remaining 157 patients who did not receive additional therapy (RT or hormonal) prior to metastatic onset formed the no RT group. Clinical-genomic risk was assessed by CAPRA-S and Decipher. Cox univariable (UVA) and multivariable (MVA) proportional hazards models were used to evaluate the impact of treatment on outcome. RESULTS During study follow-up, 37 patients developed metastasis with a median follow-up of 8 years. Both CAPRA-S and Decipher had independent predictive value on MVA for metastatic outcome (both p<0.05). On MVA adjusting for clinical and genomic risk, delayed SRT and no RT had a hazard ratio (HR) of 4.31 (95% confidence interval [CI], 1.20-15.47) and 5.42 (95% CI, 1.59-18.44) for metastasis compared to ART as the reference group. No significance difference was observed between early SRT and ART groups (p=0.28). Men with low to intermediate CAPRA-S scores and low Decipher risk have a low rate of metastatic events regardless of treatment selection. In contrast, men with high CAPRA-S and Decipher scores benefit from ART, however the cumulative incidence of metastasis remains high. CONCLUSIONS The decision as to the timing and need for additional local therapy following RP is nuanced and requires providers and patients to balance risks of morbidity with improved oncologic outcomes. This analysis provides the most robust and accurate quantification of risk for these patients. Post-RP treatment can be safely avoided for men who are low risk by clinical-genomic risk, whereas those at high risk should strongly favor enrollment in clinical trials. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e148 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Ashley Ross More articles by this author Robert Den More articles by this author Kasra Yousefi More articles by this author Bruce Trock More articles by this author Elai Davicioni More articles by this author Jeffrey Tosoian More articles by this author Darby Thompson More articles by this author Voleak Choeurng More articles by this author Zaid Haddad More articles by this author Phuoc Tran More articles by this author Edouard Trabulsi More articles by this author Leonard Gomella More articles by this author Costas Lallas More articles by this author Firas Abdollah More articles by this author Felix Feng More articles by this author Adam Dicker More articles by this author Stephen Freedland More articles by this author Jeffrey Karnes More articles by this author Edward Schaeffer More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...