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Trabulsi EJ, Valicenti RK, Hanlon AL, Pisansky TM, Sandler HM, Kuban DA, Catton CN, Michalski JM, Zelefsky MJ, Kupelian PA, Lin DW, Anscher MS, Slawin KM, Roehrborn CG, Forman JD, Liauw SL, Kestin LL, DeWeese TL, Scardino PT, Stephenson AJ, Pollack A
A Multi-Institutional Matched-Control Analysis of Adjuvant and Salvage Postoperative Radiation Therapy for pT3-4N0 Prostate Cancer
Urology (2008) 72:1298-1302.
Abstract
OBJECTIVES It is unclear whether postoperative salvage radiation therapy (SRT) and early adjuvant radiotherapy (ART) after radical prostatectomy lead to equivalent long-term tumor control. We studied a group of patients undergoing ART by comparing them with a matched control group undergoing SRT after biochemical failure. METHODS Using a multi-institutional database of 2299 patients, 449 patients with pT3-4N0 disease were eligible for inclusion, including 211 patients receiving ART and 238 patients receiving SRT. Patients were matched in a 1:1 ratio according to preoperative prostate-specific antigen Gleason score, seminal vesicle invasion, surgical margin status, and follow-up from date of surgery. RESULTS A total of 192 patients were matched (96:96). The median follow-up was 94 months from Surgery and 73 months from RT completion. There was a significant reduction in biochemical failure with ART compared with SRT. The 5-year freedom from biochemical failure (FFBF) from Surgery was 75% after ART, compared with 66% for SRT (hazard ratio [HR] = 1.6, P =.049). The 5-year FFBF from the end of RT was 73% after ART, compared with 50% after SRT (HR = 2.3, log rank [LR] P =.0007). From the end of RT, SRT and Gleason score >= 8 were independent predictors of diminished FFBF. From the date Of Surgery, Gleason score >= 8 was a significant predictor of FFBF. CONCLUSIONS Early ART for pT3-4N0 prostate cancer significantly reduces the risk of long-term biochemical progression after radical prostatectomy compared with SRT. Gleason score >= 8 was the only factor on multivariate analysis associated with metastasic progression. UROLOGY 72: 1298-1302, 2008. (C) 2008 Elsevier Inc.
Note
Publication Date: 2008-12-01.
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