Adjuvant Versus Early Salvage Radiation Therapy for Men at High Risk for Recurrence Following Radical Prostatectomy for Prostate Cancer and the Risk of Death

In the July 10, 2021 edition of Journal of Clinical Oncology, Derya Tilki and colleagues report on the results of a trial of early salvage radiotherapy in men with high-risk prostate cancer


The purpose of the study was to compare early salvage radiation therapy (sRT) following radical prostatectomy (RP) in men with adverse pathologic features to determine if there is an improvement in progression-free survival 


The authors evaluated the impact of adjuvant versus early salvage radiotherapy on all-cause mortality risk in men with adverse pathology defined as positive pelvic lymph nodes (pN1) or Gleason score 8-10 prostate cancer (PC) and disease extending beyond the prostate (pT3/4). A treatment propensity score to minimize potential treatment selection bias when estimating the causal effect of adjuvant versus early salvage radiotherapy on all cause mortality risk was utilized. A sensitivity analysis to assess the impact that varying definitions of adverse pathology had on all cause mortality risk adjusting for variables such as age during surgery, other prognostic factors, site, and time-dependent utilization of ADT in the postsurgical setting .


After a median follow-up of 8.16 (6.00-12.10) years, of the 26,118 men in the study cohort, 2,104 (8.06%) died, of which 539 (25.62%) were from prostate cancer. After excluding men with a persistent PSA, adjuvant compared with early salvage radiotherapy was associated with a significantly lower all cause mortality risk among men with adverse pathologic features at radical prostatectomy when men with pN1 PC were excluded (0.33 [0.13-0.85]; P = .02) or included (0.66 [0.44-0.99]; P = .04).


The authors concluded that ” Adjuvant radiation therapy should be considered in men with pN1 or Gleason score 8 to 10 and pT3/4 prostate cancer given the possibility that a significant reduction in all-cause mortality risk exists “