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Posted by on May 11, 2013 in Prostate cancer | 0 comments

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In a nutshell

The present study evaluated whether patients with stage III prostate cancer (PCa) who underwent radical prostatectomy (RP) would benefit from further radiotherapy (RT), as opposed to the "wait and see" approach. There was a 21% increase in survival with no cancer progression in patients who received additional RT. 

Some background

Stage III PCa means that the cancer has spread beyond the prostate gland, but has not yet reached the bladder, rectum (the lowest part of the large bowel), lymph nodes or distant organs. These patients usually benefit from RP (surgical removal of the cancer along with the prostate gland and some healthy tissue around it). Usually if all the cancer has been removed the blood PSA (prostate specific antigen – a protein specific to the prostate gland whose levels rise in prostate disease) levels drop to an undetectable level. Some patients may also benefit from additional RT to make sure the cancer has been completely removed. However, RP and RT together may have serious side effects such as bladder, bowel or sexual problems. Therefore, some patients with undetectable PSA levels after RP can be regularly monitored for signs of a recurrence (return of the cancer). This is called the “wait and see” approach (also known as active surveillance).

Methods & findings

This study included 307 PCa patients who had undetectable PSA levels after RP. After the surgery patients were randomly assigned to either receive additional RT or to undergo close monitoring (wait and see group). Also, all tissues removed during surgery were sent to a pathologist for examination. He can tell for sure if the cancer was completely removed by checking the healthy tissue around the cancer for remaining cancer cells. The parameters evaluated were progression-free survival or PFS (defined as the percentage of patients who have survived for a certain period of time, without progression of their cancer) and positive surgical margins or PSM (the presence of remaining cancer cells in the healthy tissue surrounding the cancer which was removed during surgery) in the pathology review.
 
After approximately 4 years of follow up, the PFS increased to 81% for patients in the RT group compared with 60% for the wait and see group. 69.4% of patients had PSM after the pathology review. Patients with PSM, who had a more advanced disease (Gleason score > 6) and a high PSA level before surgery (>10ng/ml) had significant benefit from radiotherapy in terms of pathology review.

The bottom line

In this study, patients with stage III PCa who received RT after RP had a 21% increase in PFS compared to those who were closely monitored. Patients with more advanced cancer (Gleason score > 6) and PSM benefited the most from the combined approach.

The fine print

Only cases with stage III PCa with or without PSM were included in this study so it is not certain whether this approach would be beneficial to other PCa patients. 

Published By :

European Urology

Date :

Mar 17, 2013

Original Title :

Phase 3 Study of Adjuvant Radiotherapy Versus Wait and See in pT3 Prostate Cancer: Impact of Pathology Review on Analysis

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