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Adjuvant Versus Early Salvage Radiation Therapy for Men at High Risk for Recurrence Following Radical Prostatectomy for Prostate Cancer and the Risk of Death

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Adjuvant Versus Early Salvage Radiation Therapy for Men at High Risk for Recurrence Following Radical Prostatectomy for Prostate Cancer and the Risk of Death. / Tilki, Derya; Chen, Ming-Hui; Wu, Jing; Huland, Hartwig; Graefen, Markus; Wiegel, Thomas; Böhmer, Dirk; Mohamad, Osama; Cowan, Janet E; Feng, Felix Y; Carroll, Peter R; Trock, Bruce J; Partin, Alan W; D'Amico, Anthony V.

In: J CLIN ONCOL, Vol. 39, No. 20, 10.07.2021, p. 2284-2293.

Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review

Harvard

Tilki, D, Chen, M-H, Wu, J, Huland, H, Graefen, M, Wiegel, T, Böhmer, D, Mohamad, O, Cowan, JE, Feng, FY, Carroll, PR, Trock, BJ, Partin, AW & D'Amico, AV 2021, 'Adjuvant Versus Early Salvage Radiation Therapy for Men at High Risk for Recurrence Following Radical Prostatectomy for Prostate Cancer and the Risk of Death', J CLIN ONCOL, vol. 39, no. 20, pp. 2284-2293. https://doi.org/10.1200/JCO.20.03714

APA

Tilki, D., Chen, M-H., Wu, J., Huland, H., Graefen, M., Wiegel, T., Böhmer, D., Mohamad, O., Cowan, J. E., Feng, F. Y., Carroll, P. R., Trock, B. J., Partin, A. W., & D'Amico, A. V. (2021). Adjuvant Versus Early Salvage Radiation Therapy for Men at High Risk for Recurrence Following Radical Prostatectomy for Prostate Cancer and the Risk of Death. J CLIN ONCOL, 39(20), 2284-2293. https://doi.org/10.1200/JCO.20.03714

Vancouver

Tilki D, Chen M-H, Wu J, Huland H, Graefen M, Wiegel T et al. Adjuvant Versus Early Salvage Radiation Therapy for Men at High Risk for Recurrence Following Radical Prostatectomy for Prostate Cancer and the Risk of Death. J CLIN ONCOL. 2021 Jul 10;39(20):2284-2293. https://doi.org/10.1200/JCO.20.03714

Bibtex

@article{c40c49255ff04765b54e4581809675a3,
title = "Adjuvant Versus Early Salvage Radiation Therapy for Men at High Risk for Recurrence Following Radical Prostatectomy for Prostate Cancer and the Risk of Death",
abstract = "PURPOSE: Adjuvant compared with early salvage radiation therapy (sRT) following radical prostatectomy (RP) has not been shown to reduce progression-free survival in randomized controlled trials. However, these trials might have missed a benefit in men with adverse pathology at RP given that these men were under-represented and immortal time bias might have been present; herein, we investigate this possibility.METHODS: We evaluated the impact of adjuvant versus early sRT on all-cause mortality (ACM) risk in men with adverse pathology defined as positive pelvic lymph nodes (pN1) or pGleason score 8-10 prostate cancer (PC) and disease extending beyond the prostate (pT3/4). We used a treatment propensity score to minimize potential treatment selection bias when estimating the causal effect of adjuvant versus early sRT on ACM risk and a sensitivity analysis to assess the impact that varying definitions of adverse pathology had on ACM risk adjusting for age at RP, PC prognostic factors, site, and the time-dependent use of post-RP androgen deprivation therapy.RESULTS: After a median follow-up (interquartile range) of 8.16 (6.00-12.10) years, of the 26,118 men in the study cohort, 2,104 (8.06%) died, of which 539 (25.62%) were from PC. After excluding men with a persistent prostate-specific antigen, adjuvant compared with early sRT was associated with a significantly lower ACM risk among men with adverse pathology at RP when men with pN1 PC were excluded (0.33 [0.13-0.85]; P = .02) or included (0.66 [0.44-0.99]; P = .04).CONCLUSION: Adjuvant radiation therapy should be considered in men with pN1 or pGleason score 8 to 10 and pT3/4 PC given the possibility that a significant reduction in ACM risk exists.",
keywords = "Aged, Clinical Decision-Making, Databases, Factual, Disease Progression, Germany, Humans, Lymphatic Metastasis, Male, Middle Aged, Neoplasm Grading, Neoplasm Staging, Progression-Free Survival, Prospective Studies, Prostatectomy/adverse effects, Prostatic Neoplasms/mortality, Radiotherapy, Adjuvant, Retrospective Studies, Risk Assessment, Risk Factors, Salvage Therapy/adverse effects, Time Factors, Time-to-Treatment, United States",
author = "Derya Tilki and Ming-Hui Chen and Jing Wu and Hartwig Huland and Markus Graefen and Thomas Wiegel and Dirk B{\"o}hmer and Osama Mohamad and Cowan, {Janet E} and Feng, {Felix Y} and Carroll, {Peter R} and Trock, {Bruce J} and Partin, {Alan W} and D'Amico, {Anthony V}",
year = "2021",
month = jul,
day = "10",
doi = "10.1200/JCO.20.03714",
language = "English",
volume = "39",
pages = "2284--2293",
journal = "J CLIN ONCOL",
issn = "0732-183X",
publisher = "American Society of Clinical Oncology",
number = "20",

}

RIS

TY - JOUR

T1 - Adjuvant Versus Early Salvage Radiation Therapy for Men at High Risk for Recurrence Following Radical Prostatectomy for Prostate Cancer and the Risk of Death

AU - Tilki, Derya

AU - Chen, Ming-Hui

AU - Wu, Jing

AU - Huland, Hartwig

AU - Graefen, Markus

AU - Wiegel, Thomas

AU - Böhmer, Dirk

AU - Mohamad, Osama

AU - Cowan, Janet E

AU - Feng, Felix Y

AU - Carroll, Peter R

AU - Trock, Bruce J

AU - Partin, Alan W

AU - D'Amico, Anthony V

PY - 2021/7/10

Y1 - 2021/7/10

N2 - PURPOSE: Adjuvant compared with early salvage radiation therapy (sRT) following radical prostatectomy (RP) has not been shown to reduce progression-free survival in randomized controlled trials. However, these trials might have missed a benefit in men with adverse pathology at RP given that these men were under-represented and immortal time bias might have been present; herein, we investigate this possibility.METHODS: We evaluated the impact of adjuvant versus early sRT on all-cause mortality (ACM) risk in men with adverse pathology defined as positive pelvic lymph nodes (pN1) or pGleason score 8-10 prostate cancer (PC) and disease extending beyond the prostate (pT3/4). We used a treatment propensity score to minimize potential treatment selection bias when estimating the causal effect of adjuvant versus early sRT on ACM risk and a sensitivity analysis to assess the impact that varying definitions of adverse pathology had on ACM risk adjusting for age at RP, PC prognostic factors, site, and the time-dependent use of post-RP androgen deprivation therapy.RESULTS: After a median follow-up (interquartile range) of 8.16 (6.00-12.10) years, of the 26,118 men in the study cohort, 2,104 (8.06%) died, of which 539 (25.62%) were from PC. After excluding men with a persistent prostate-specific antigen, adjuvant compared with early sRT was associated with a significantly lower ACM risk among men with adverse pathology at RP when men with pN1 PC were excluded (0.33 [0.13-0.85]; P = .02) or included (0.66 [0.44-0.99]; P = .04).CONCLUSION: Adjuvant radiation therapy should be considered in men with pN1 or pGleason score 8 to 10 and pT3/4 PC given the possibility that a significant reduction in ACM risk exists.

AB - PURPOSE: Adjuvant compared with early salvage radiation therapy (sRT) following radical prostatectomy (RP) has not been shown to reduce progression-free survival in randomized controlled trials. However, these trials might have missed a benefit in men with adverse pathology at RP given that these men were under-represented and immortal time bias might have been present; herein, we investigate this possibility.METHODS: We evaluated the impact of adjuvant versus early sRT on all-cause mortality (ACM) risk in men with adverse pathology defined as positive pelvic lymph nodes (pN1) or pGleason score 8-10 prostate cancer (PC) and disease extending beyond the prostate (pT3/4). We used a treatment propensity score to minimize potential treatment selection bias when estimating the causal effect of adjuvant versus early sRT on ACM risk and a sensitivity analysis to assess the impact that varying definitions of adverse pathology had on ACM risk adjusting for age at RP, PC prognostic factors, site, and the time-dependent use of post-RP androgen deprivation therapy.RESULTS: After a median follow-up (interquartile range) of 8.16 (6.00-12.10) years, of the 26,118 men in the study cohort, 2,104 (8.06%) died, of which 539 (25.62%) were from PC. After excluding men with a persistent prostate-specific antigen, adjuvant compared with early sRT was associated with a significantly lower ACM risk among men with adverse pathology at RP when men with pN1 PC were excluded (0.33 [0.13-0.85]; P = .02) or included (0.66 [0.44-0.99]; P = .04).CONCLUSION: Adjuvant radiation therapy should be considered in men with pN1 or pGleason score 8 to 10 and pT3/4 PC given the possibility that a significant reduction in ACM risk exists.

KW - Aged

KW - Clinical Decision-Making

KW - Databases, Factual

KW - Disease Progression

KW - Germany

KW - Humans

KW - Lymphatic Metastasis

KW - Male

KW - Middle Aged

KW - Neoplasm Grading

KW - Neoplasm Staging

KW - Progression-Free Survival

KW - Prospective Studies

KW - Prostatectomy/adverse effects

KW - Prostatic Neoplasms/mortality

KW - Radiotherapy, Adjuvant

KW - Retrospective Studies

KW - Risk Assessment

KW - Risk Factors

KW - Salvage Therapy/adverse effects

KW - Time Factors

KW - Time-to-Treatment

KW - United States

U2 - 10.1200/JCO.20.03714

DO - 10.1200/JCO.20.03714

M3 - SCORING: Journal article

C2 - 34086480

VL - 39

SP - 2284

EP - 2293

JO - J CLIN ONCOL

JF - J CLIN ONCOL

SN - 0732-183X

IS - 20

ER -