UROLOGICAL SURVEY
Urological Oncology
External beam radiation therapy after radical prostatectomy: efficacy and impact on urinary continence
Petroski RA, Warlick WB, Herring J, Donahue TF, Sun L, Smith CV, Connelly RR, McLeod DG, Moul JW
Center for Prostate Disease Research (CPDR), Rockville, Maryland, USA
Prostate Cancer Prostatic Dis. 2004; 7: 170-7
INTRODUCTION AND OBJECTIVES: The efficacy of adjuvant and salvage external beam radiation (AXRT+SXRT) for prostate cancer after radical prostatectomy (RP) has been debated because of the inability to rule out systemic occult metastasis, uncertainty that radiation eradicates residual local disease and the potential of exacerbating impotency and incontinence. To characterize the effectiveness and treatment morbidity a retrospective review was performed.
METHODS: In all, 38 patients received AXRT and 91 received SXRT. The SXRT group was stratified by PSA level, age, race, pathologic stage, margin status, worst Gleason sum, radiation dose and pelvic field. Complications evaluated were impotence and incontinence. Median follow-up was 60.2 months.
RESULTS: The 5-y disease-free survival (DFS) rate was 61.3% for AXRT and 36.3% for SXRT. Multivariate analysis of the SXRT cohort showed Gleason score, pathologic stage and pre-XRT PSA to be predictors of disease recurrence. After XRT 26% had worsened continence.
CONCLUSIONS: Patients who recur after RP whose pathologic stage is pT2 or pT3c, Gleason score of 8 or higher or pre-XRT PSA is > 2.0 ng/dL may have microscopic metastatic disease and a decreased chance of cure with SXRT alone. Continence was further impaired after XRT.
Editorial Comment
A current treatment option for positive margins after radical prostatectomy (RP) (required by up to 35% within 5 years after RP) is adjuvant external beam radiation (AXRT), if PSA progression already has occurred salvage external beam radiation (SXRT) often is performed. Outcomes and side effects of these approaches have been documented in the current paper from two large institutions.
The AXRT group had a 5-year disease-free survival (DFS) rate of 61.3%; the SXRT group DFS was 36.3%. Post-RP PSA below 2 ng/mL was a significant determinant of success.
Most interesting are data on side effects of this approach. In all groups a significant deterioration of continence occurred. After XRT 10% of previously continent patients became incontinent and 14% became partially incontinent. These data are even worse in partially continent patients after RP.
Thus, additional radiation treatment should be advocated with a note of caution to patients with PSA progression, and benefits should be weighted against disadvantages.
Dr. Andreas Bohle
Professor of Urology
HELIOS Agnes Karll Hospital
Bad Schwartau, Germany
Publication Dates
-
Publication in this collection
05 Oct 2005 -
Date of issue
Aug 2005
