Abstract
Background and purpose
Results following radical prostatectomy (RP) are suboptimal in patients found to have
cancer extending beyond the prostatic capsule (pT3) or present at the resection margins
(R1). The optimal postoperative management of such patients is undefined. Therapeutic
alternatives include adjuvant radiotherapy (RT) or active surveillance.
Methods
Randomized controlled trials (RCTs) were eligible for inclusion in this systematic
review if they compared adjuvant RT in the immediate period after RP to active surveillance
– with therapies held in reserve for salvage – in prostate cancer patients with pT3
or R1 disease or both. The primary outcome of interest was overall survival.
Results
Three RCTs representing 1743 patients satisfied the eligibility criteria. Two trials
reported data on overall survival; a meta-analysis of the data showed no significant
improvement associated with adjuvant RT (hazard ratio = 0.91, 95% CI 0.67–1.22, p = 0.52). All trials reported data on biochemical progression-free survival (bPFS). On
meta-analysis, adjuvant RT significantly improved bPFS (hazard ratio = 0.47, 95% CI 0.40–0.56, p < 0.00001). One trial provided comparative graded toxicity data; there were no significant
differences between arms in severe (⩾grade 3) gastrointestinal or genitourinary toxicity
at five years.
Conclusions
To date, adjuvant RT has not been shown to improve overall survival compared with
active surveillance. Longer follow-up from completed RCTs is required to accurately
assess this outcome. Adjuvant RT does, however, significantly improve bPFS and is
not associated with excess severe late toxicity.
Keywords
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Article info
Publication history
Published online: May 23, 2008
Accepted:
April 24,
2008
Received in revised form:
April 22,
2008
Received:
February 27,
2008
Identification
Copyright
© 2008 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
