Patterns of care and outcomes of radiotherapy for lymph node positivity after radical prostatectomy

• Published in: BJU international Vol. 111; no. 8; pp. 1208 - 1214
• Main Authors: Kaplan, Joshua R., Kowalczyk, Keith J., Borza, Tudor, Gu, Xiangmei, Lipsitz, Stuart R., Nguyen, Paul L., Friedlander, David F., Trinh, Quoc‐Dien, Hu, Jim C.
• Format: Journal Article
• Language: English
• Published: Oxford Wiley-Blackwell 01-06-2013; Wiley Subscription Services, Inc
• Subjects: Aged; Biological and medical sciences; Disease-Free Survival; Follow-Up Studies; Genital system. Mammary gland; Humans; Lymph Nodes - pathology; Lymphatic Metastasis; Lymphatic system; Male; Medical sciences; Metastasis; Middle Aged; Mortality; Nephrology. Urinary tract diseases; outcomes; Propensity Score; Prospective Studies; Prostate cancer; Prostatectomy - methods; Prostatic Neoplasms - radiotherapy; Prostatic Neoplasms - secondary; Prostatic Neoplasms - surgery; radiation therapy; radical prostatectomy; Radiotherapy, Adjuvant; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Retrospective Studies; SEER Program; Survival Rate - trends; Treatment Outcome; Tumors of the urinary system; United States - epidemiology; Urinary tract. Prostate gland; United States; Human; Nephrology; Urinary system disease; Prognosis; Prostate disease; Adjuvant treatment; Malignant lymphadenopathy; Malignant hemopathy; Malignant tumor; Radiotherapy; Survival; Urology; Lymph node metastasis; Cancerology; Treatment; radical prostatectomy; outcomes; Surgery; radiation therapy; Prostatectomy; Combined treatment; Male genital diseases; Prostate cancer; Cancer
• ISSN: 1464-4096; 1464-410X
• DOI: 10.1111/bju.12079

Objective
To evaluate the use and outcomes of adjuvant radiation therapy (ART) for men with lymph node (LN)‐positive disease after radical prostatectomy (RP) using a population‐based approach.
Patients and Methods
Surveillance, Epidemiology, and End Results (SEER)‐Medicare linked data from 1995 to 2007 was used to identify 577 men with LN metastases discovered during RP and absence of distant metastases, of which 177 underwent ART ≤1 year of RP.
Propensity score models were used to compare overall mortality and prostate cancer‐specific mortality (PCSM) for men that did and those that did not receive ART.
Results
Men in both groups received adjuvant androgen‐deprivation therapy at similar rates after propensity weighting adjustments (33.6% vs 33.7%, P = 0.977).
ART was not associated with differences in overall (5.09 vs 3.77 events per 100 person‐years, P = 0.153) or PCSM (2.89 vs 1.31, P = 0.090) relative to men who did not receive ART.
Conclusions
ART after RP in men with LN‐positive prostate cancer was not associated with improved overall or disease‐specific survival, in contrast to previous single‐centre studies.
Prospective randomised studies are needed to assess the effectiveness of ART in this patient population.