PROSTATE CANCER ADJUVANT & SALVAGE THERAPY

SALVAGE vs. ADJUVANT RADIATION

A Jan 2021 article in everyday urology very nicely broke down a comparison of RCT of adjuvant vs. salvage RT:

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SALVAGE RADIATION

Salvage treatment is treatment for BCR after primary treatment. In salvage treatment for recurrence after treatment with EBRT, rates of fistula complications after salvage RP are 7%, cryotherapy are 11%, and brachytherapy 12%. (1) ADT with salvage RT improves outcomes (4) although one study found that it did not help if PSA <0.6. (5)

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ADJUVANT RADIATION

 Adjuvant RT is RT after primary treatment prior to BCR based on pathological findings. It is recommended for adverse pathology after RP such as positive margins (PM), extracapsular extension (ECE) or seminal vesical invasion. A RCT of 250 patients of adjuvant RT for PM or ECE found 10yr BCR free survival of 82% in the adjuvant group versus 61% in the observation group (hazard ratio [HR] 0.26 with most of the observation group getting salvage radiation (2) .  

One study showed there was no benefit to adjuvant RT (3)

(2)

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1. Peters, Max, et al. "Patterns of outcome and toxicity after salvage prostatectomy, salvage cryosurgery and salvage brachytherapy for prostate cancer recurrences after radiation therapy: a multi-center experience and literature review." World journal of urology 31.2 (2013): 403-409.
2. Amling, C. Adjuvant radiotherapy after prostatectomy-when should we use it.  AUA News, June 2019.
3. Parker, C., et al. “LBA49_PRTiming of Radiotherapy (RT) after Radical Prostatectomy (RP): First Results from the RADICALS RT Randomised Controlled Trial (RCT) [NCT00541047].” Annals of Oncology, vol. 30, 2019.​
4. Carrie, Christian, et al. "Short-term androgen deprivation therapy combined with radiotherapy as salvage treatment after radical prostatectomy for prostate cancer (GETUG-AFU 16): a 112-month follow-up of a phase 3, randomised trial." The Lancet Oncology (2019).
5. https://www.medpagetoday.com/meetingcoverage/astro/82181
6. https://www.urotoday.com/journal/everyday-urology-oncology-insights/articles/126011-post-operative-radiotherapy-in-prostate-cancer-the-state-of-the-data.html    -   Accessed 2/13/2021