ADJUVANT RT FOR POSITIVE MARGINS OR EXTRACAPPULAR EXTNSION PROTATE CANCER

• Based on PSA measurements, 82% of patients in the adjuvant radiotherapy group were disease-free at the end of the follow-up period vs 61% in the prostatectomy-alone group.
• No metastases were detected in 98% of those in the adjuvant treatment group and 96% of those in the prostatectomy-alone group during the follow-up period.
• In the adjuvant radiotherapy group, 56% of patients experienced grade 3 adverse events vs 40% in the prostatectomy-alone group.

In patients with prostate cancer with surgical positive margins or extracapsular extension of their disease, the risk of disease recurrence postprostatectomy is higher than in cases where the cancer cells are confined within the prostate. The Finnish FinnProstataX study investigated whether radiotherapy administered after the removal of the prostate benefited patients whose cancer had spread to the surface of the prostate or beyond the capsule that surrounds the prostate. Findings were published by Hackman et al in European Urology.
Methods and Results
The randomized study carried out in 2004–2012 included 250 patients, of whom 126 received adjuvant radiotherapy after prostatectomy. The other 124 patients were treated with prostatectomy alone.
Over the roughly 9-year follow-up, only two patients—one from each group—died of prostate cancer. Based on prostate-specific antigen (PSA) measurements, 82% of patients in the adjuvant radiotherapy group were disease-free at the end of the follow-up period vs 61% in the prostatectomy-alone group. An increase in the PSA value usually precedes the recurrence of prostate cancer, and in this study, the patients with a maximum PSA of 0.4mg/L were determined to be disease-free.
No metastases were detected in 98% of those in the adjuvant treatment group and 96% of those in the prostatectomy-alone group during the follow-up period. In the adjuvant radiotherapy group, 56% of patients experienced grade 3 adverse events vs 40% in the prostatectomy-alone group (P = .016).
“Tolerance for the adjuvant treatment was good, and it prolonged the disease-free period measured from the PSA compared to the mere surgical removal of the prostate. Even so, the adjuvant treatment did not extend patients’ survival,” said study author Akseli Hemminki, MD, PhD.
“Prostate cancer may generate metastases and, in the worst case, result in death more than 10 years after the recurrence of the disease, detected from a PSA increase. Given that the patients in this study were monitored for less than 10 years on average, it’s only natural that the treatment we studied did not have a significant impact on survival. In even longer follow-up, a difference in PSA increases could also lead to a difference in mortality,” said lead study author Greetta Hackman, LicMed.
The researchers concluded, “Adjuvant radiotherapy following radical prostatectomy is generally well tolerated and prolongs biochemical recurrence-free survival compared with radical prostatectomy alone in patients with positive margins or extracapsular extension.”