Radiation therapy after radical prostatectomy for prostate cancer: evaluation of complications and influence of radiation timing on outcomes in a large, population-based cohort.

Authors

Sarah E Hegarty, Division of Biostatistics, Jefferson Medical College, Thomas Jefferson UniversityFollow
Terry Hyslop, Department of Biostatistics and Bioinformatics, Duke University School of MedicineFollow
Adam Dicker MD, PhD, Department of Radiation Oncology, Jefferson Medical College, Thomas Jefferson UniversityFollow
Timothy Showalter MD, Department of Radiation Oncology, University of Virginia School of MedicineFollow

Document Type

Article

Publication Date

2-23-2015

Comments

This article has been peer reviewed. It was published in: PLoS ONE.

Volume 10, Issue 2, 23 February 2015, Article number e0118430.

The published version is available at DOI:10.1371/journal.pone.0118430

Copyright © © 2015 Hegarty et al.

Abstract

PURPOSE: To evaluate the influence of timing of salvage and adjuvant radiation therapy on outcomes after prostatectomy for prostate cancer.

METHODS: Using the Surveillance, Epidemiology, and End Results-Medicare linked database, we identified prostate cancer patients diagnosed during 1995-2007 who had one or more adverse pathological features after prostatectomy. The final cohort of 6,137 eligible patients included men who received prostatectomy alone (n = 4,509) or with adjuvant (n = 894) or salvage (n = 734) radiation therapy. Primary outcomes were genitourinary, gastrointestinal, and erectile dysfunction events and survival after treatment(s).

RESULTS: Radiation therapy after prostatectomy was associated with higher rates of gastrointestinal and genitourinary events, but not erectile dysfunction. In adjusted models, earlier treatment with adjuvant radiation therapy was not associated with increased rates of genitourinary or erectile dysfunction events compared to delayed salvage radiation therapy. Early adjuvant radiation therapy was associated with lower rates of gastrointestinal events that salvage radiation therapy, with hazard ratios of 0.80 (95% CI, 0.67-0.95) for procedure-defined and 0.70 (95% CI, 0.59, 0.83) for diagnosis-defined events. There was no significant difference between ART and non-ART groups (SRT or RP alone) for overall survival (HR = 1.13 95% CI = (0.96, 1.34) p = 0.148).

CONCLUSIONS: Radiation therapy after prostatectomy is associated with increased rates of gastrointestinal and genitourinary events. However, earlier radiation therapy is not associated with higher rates of gastrointestinal, genitourinary or sexual events. These findings oppose the conventional belief that delaying radiation therapy reduces the risk of radiation-related complications.

Recommended Citation

Hegarty, Sarah E; Hyslop, Terry; Dicker, Adam MD, PhD; and Showalter, Timothy MD, "Radiation therapy after radical prostatectomy for prostate cancer: evaluation of complications and influence of radiation timing on outcomes in a large, population-based cohort." (2015). Department of Radiation Oncology Faculty Papers. Paper 49.
https://jdc.jefferson.edu/radoncfp/49

PubMed ID

25706657