2014, Number S2
Gac Med Mex 2014; 150 (S2)
Comparison between surveillance, adjuvant radiotherapy, or salvage radiotherapy after radical prostatectomy in patients with prostate cancer (PCa) in stage pT3 or higher and/or positive surgical margins
Rodríguez-Covarrubias F, Sotomayor-de-Zavaleta M, Castillejos-Molina R, Gabilondo-Navarro F, Feria-Bernal G
PDF size: 211.99 Kb.
To assess the mid-term evolution of high-risk prostate cancer (PCa) initially treated with radical prostatectomy
(RP) and to compare the role of surveillance and postoperative radiotherapy, either adjuvant (aRT) or salvage (sRT).
Retrospective study of 390 patients with PCa treated with RP at our institution from February 1988 to
December 2012. Those in stage pT3 or higher and/or with positive surgical margins (PSM) were included. They were
divided in three groups: group 1, undergoing surveillance after RP; group 2 receiving aRT; and group 3 receiving sRT.
Cancer-specific survival (CSS) was estimated using the Kaplan-Meier method. Results:
156 patients were analyzed.
Mean age was 63.8 ± 6.9 years (45-79). Mean follow-up was 58 ± 45 months; 71 (45.5%) had PSM, 40 (25.6%) were
in stage pT3 or higher, and 45 (28.8%) had both features. Group 1 included 91 patients, group 2, 43 and group 3, 22.
Initial prostate-specific antigen (PSA) was 12.8 ng/ml in group 1, 14.9 ng/ml in group 2, and 14.5 ng/ml in group 3
(p = 0.07). First postoperative PSA was 0.27, 0.87, and 0.50 ng/ml in group 1, 2 and 3, respectively (p = 0.007).
Seven men died of PCa: three in group 1, three in group 2, and one in group 3 (p = 0.6). The CSS at five and 10 years
was 100 and 89% for group 1, 95 and 80% for group 2, and 94 and 94% for group 3 (p = 0.71). Conclusion:
retrospectively show that surveillance, aRT and sRT are equivalent for the mid-term control of PCa after RP
International Agency for Research on Cancer. [Internet] Consultado el 5 de febrero de 2013. Disponible en: http://globocan.iarc.fr/factsheet.asp.
Schröder FH, Hugosson J, Roobol MJ, et al. Prostate-cancer mortality at 11 years of follow-up. N Eng J Med. 2012;366:981-90.
Han M, Partin AW, Zahurak M, Piantadosi S, Epstein JI, Walsh PC. Biochemical (prostate specific antigen) recurrence probability following radical prostatectomy for clinically localized prostate cancer. J Urol. 2003;169:517-23.
Rodríguez-Covarrubias F, Castillejos R, Sotomayor M, Gabilondo F, Feria G. The outcome of patients with prostate cancer and adverse pathological characteristics treated with radical prostatectomy. Eur Urol Suppl. 2008;7:251.
Swanson GP, Basler JW. Prognostic factors for failure after prostatectomy. J Cancer. 2011;2:1-19.
Epstein JI, Amin M, Boccon-Gibod L, et al. Prognostic factors and reporting of prostate carcinoma in radical prostatectomy and pelvic lymphadenectomy specimens. Scand J Urol Nephrol Suppl. 2005; 216:34-63.
Bolla M, van Poppel H, Collette L, et al. Postoperative radiotherapy after radical prostatectomy: a randomised controlled trial (EORTC trial 22911). Lancet. 2005;366:572-8.
Thompson IM, Tangen CM, Paradelo J, et al. Adjuvant radiotherapy for pathological T3N0M0 prostate cancer significantly reduces risk of metastases and improves survival: long-term followup of a randomized clinical trial. J Urol. 2009;181:956-62.
Wiegel T, Bottke D, Steiner U, et al. Phase III postoperative adjuvant radiotherapy after radical prostatectomy compared with radical prostatectomy alone in pT3 prostate cancer with postoperative undetectable prostate-specific antigen: ARO 96–02/AUO AP 09/95. J Clin Oncol. 2009;27:2924-30.
Loeb S, Roehl K, Viprakasit D, Catalona W. Long-term rates of undetectable PSA with initial observation and delayed salvage radiotherapy after radical prostatectomy. Eur Urol. 2008;54:88-94.
Parker C, Sydes MR, Catton C, et al. Radiotherapy and androgen deprivation in combination after local surgery (RADICALS): a new Medical Research Council/National Cancer Institute of Canada phase III trial of adjuvant treatment after radical prostatectomy. BJU Int. 2007; 99:1376-9.
Sobin LH, Gospodariwicz M, Wittekind C. TNM classification of malignant tumors UICC International Union Against Cancer. 7.a ed. Wiley-Blackwell. Chichester, West Sussex, UK; 2009. p. 243-8.
Stephenson AJ, Bolla M, Briganti A, et al. Postoperative radiation therapy for pathological advanced prostate cancer after radical prostatectomy. Eur Urol. 2012;61:443-51.
Van der Kwast TH, Bolla M, Van Poppel H, et al. Identification of patients with prostate cancer who benefit from immediate postoperative radiotherapy. EORTC 22911. J Clin Oncol. 2007;25:4178-86.
Arceo-Olaiz R, de-Anda-González J, Urbina-Ramírez S, et al. Los márgenes quirúrgicos positivos disminuyen la supervivencia cáncer específica de los pacientes con cáncer de próstata tratados con prostatectomía radical: experiencia en un centro de tercer nivel en México. Gac Med Mex. 2013;149:286-91.
King CR. Adjuvant versus salvage radiotherapy after prostatectomy: the apple versus the orange. Int J Radiation Oncology Biol Phys. 2012; 83:1045-6.