The Study: The Shipley, SPPORT, and GETUG trials have given us recent data to use in treating salvage prostate cancer after prostatectomy. But when it comes to adjuvant therapy for high-risk features, we’re still stuck with aging data from the SWOG, EORTC, and German trials. These trials have many caveats including the fact that many of the patients treated “adjuvantly” were really receiving salvage therapy for persistently elevated PSA. The FinnProstataX trial gives us some much needed recent data for the adjuvant setting. This trial was limited to patients with positive margins and/or extra-prostatic extension and whose post-prostatectomy PSA was < 0.5 ng/ml. Wait, what was that? Oh yea, roughly half of these patients had a post-op PSA between 0.2 and 0.5 ng/ml (i.e., friggin’ early salvage!). The adjuvant group was treated with 3D-conformal radiation to 1.8 Gy x 37 = 66.6 Gy. At 10 years, there was a significant improvement in the primary endpoint of biochemical recurrence-free survival from 61% to 82%. However, there was no difference in overall, prostate cancer-specific, or metastasis-free survival. There was also no difference in the rate of distant metastasis or castration resistance. Where does this leave us? Pretty much where we started--knowing that adjuvant radiation reduces biochemical failures but not knowing if early salvage treatment is just as effective for the patients who really need it.
TBL: Adjuvant post-prostatectomy radiation in men with positive margins and/or extra-prostatic extension improves biochemical recurrence-free survival. | Hackman, European Urology 2019