Purpose
Prostate cancer is one of the most common malignancies in men, with radical prostatectomy and radiotherapy (RT) being the primary curative treatments for localised disease. The risk of disease recurrence after prostatectomy depends on characteristics including pre-operative PSA, Gleason score, extraprostatic extension (EPE), seminal vesicle invasion (SVI), and positive surgical margins (PSM) [1]. Post prostatectomy radiotherapy (PPRT) to the prostate bed is an effective treatment for prostate cancer, often categorised into adjuvant radiotherapy (delivered to reduce the risk of disease recurrence for high risk pathological...
Methods and materials
A retrospective review of patient outcomes was performed on medical records for patients treated at one centre with curative intent radiotherapy to the prostate bed after RP for prostate adenocarcinoma between 2007 and 2009 with pT2-4N0M0 R0-1 histopathology. Exclusion criteria included patients treated with elective pelvic nodal radiotherapy. Local institutional approval was obtained for the study. Data was collected from January to February 2019.
Patients were treated with 52.5Gy in 20 fractions over 4 weeks using a 4 field 3D conformal technique, undergoing CT simulation...
Results
The number of FFBF, DM, CSM and OS events were 53, 15, 11 and 29 respectively. Kaplan Meier estimates for FFBF at 5 and 10 years was 68% (95% CI 59%-77%) and 51% (95% CI 43%-62%). Kaplan Meier estimates for OS at 5 and 10 years was 90% (95% CI 85%-96%) and 75% (95% CI 68%-84%). Cumulative incidence of DM at 5 and 10 years was 7% (95% CI 2%-12%) and 16% (95% CI 8%-23%). Cumulative incidence of CSM at 5 and 10 years was...
Conclusion
Hypofractionated SRT after prostatectomy leads to two thirds of patients being free from BF at 10 years when RT is initiated with a pre-SRT PSA ≤0.2.
We provided an external validation of the Tendulkar nomogram in a cohort of patients with 10-year median follow up, supporting the long-term efficacy of HRT being comparable to CRT.
Prospective studies comparing HRT and CRT in the PPRT setting are warranted to establish the comparative efficacy and toxicity of hypofractionated post prostatectomy RT.
Personal information
Corresponding author: Stephen Chin BSc MBBS FRANZCR,
[email protected], Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
References
Remmers S, Verbeek JFM, Nieboer D, van der Kwast T, Roobol MJ. Predicting biochemical recurrence and prostate cancer specific mortality after radical prostatectomy: comparison of six prediction models in a cohort of screen and clinically detected prostate cancer patients. BJU Int. Wiley Online Library; 2019; doi:10.1111/bju.14790
Trock BJ, Han M, Freedland SJ, Humphreys EB, DeWeese TL, Partin AW, et al. Prostate cancer-specific survival following salvage radiotherapy vs observation in men with biochemical recurrence after radical prostatectomy. JAMA. American Medical Association; 2008;299: 2760–2769.
Parker C, Clarke...