Document Type
Article
Publication Date
5-8-2025
Abstract
Background/Objectives: Data from clinical trials showing the non-inferiority of early salvage radiotherapy were recently incorporated into societal guideline statements. However, questions remain regarding ideal prostate-specific antigen (PSA) criteria for salvage, and how to apply these findings to pathologic lymph node-positive (pN+) disease. We investigated variance in management of clinically localized prostate cancer found to have high-risk features after radical prostatectomy. Methods: We retrospectively identified patients from May 2015 to January 2024 utilizing a multi-institutional, regional collaborative database. The primary outcome was identifying factors associated with the receipt of adjuvant versus salvage therapy. Factors associated with secondary treatment were assessed via multivariable logistic regression. Results: In total, 230 (38%) patients received adjuvant and 375 (62%) received salvage therapy. Rates of adjuvant versus salvage therapy differed by practice setting (p < 0.001). A higher percentage of patients received salvage (38.9%) over adjuvant (13.5%) therapy in or after 2020 (p < 0.001). In our model, patients with preoperative PSA ≥ 10 ng/mL (OR: 2.15, CI: 1.31–3.53) and treatment in or after 2020 (OR: 3.41, CI: 1.75–6.66) had higher odds, while patients with persistent detectable postoperative PSA ≥ 0.1 ng/mL had lower odds (OR: 0.39, CI: 0.20–0.74) of undergoing salvage therapy. Among pN+ patients, 51% received adjuvant and 49% received salvage therapy. Conclusions: The management of high-risk prostate cancer remains varied. In our regional cohort, rates of salvage versus adjuvant therapy increased after publication of level-one evidence. Further work is warranted to better delineate who will most benefit from adjuvant versus early salvage therapy. © 2025 by the authors.
Recommended Citation
Hochberg, Aaron R.; Ho, Annie H.; Thompson, Rasheed A. M.; Buck, Matthew B.; Lallas, Costas D.; Ibilibor, Christine; Tomaszewski, Jeffrey J.; Ginzburg, Serge; Correa, Andres; Uzzo, Robert; Smaldone, Marc C.; Danella, John F.; Guzzo, Thomas J.; Lee, Daniel J.; Belkoff, Laurence; Walker, Jeffrey; Raman, Jay D.; Clark, Roderick K.; Reese, Adam; Jacobs, Bruce; Jang, Thomas; Kowalczyk, Keith J.; Smith, Meghan; and Shah, Mihir S., "Real-World Management of High-Risk Prostate Cancer Post-Radical Prostatectomy: Insights from a Regional Quality Collaborative" (2025). Department of Urology Faculty Papers. Paper 91.
https://jdc.jefferson.edu/urologyfp/91
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.
PubMed ID
40427099
Language
English
Comments
This article is the author's final published version in Cancers, Volume 17, Issue 10, May 2025, Article Number 1600.
The published version is available at https://doi.org/10.3390/cancers17101600. Copyright © The Authors.