Pd57-09 Adjuvant or Early Salvage Radiotherapy in Node Positive Prostate Cancer Patients: Development of a Novel Risk Score to Identify the Optimal Candidate for Early Intensification Approaches Based on a Large, Multi-Institutional Series

You have accessJournal of UrologyProstate Cancer: Localized: Radiation Therapy (PD57)1 May 2024PD57-09 ADJUVANT OR EARLY SALVAGE RADIOTHERAPY IN NODE POSITIVE PROSTATE CANCER PATIENTS: DEVELOPMENT OF A NOVEL RISK SCORE TO IDENTIFY THE OPTIMAL CANDIDATE FOR EARLY INTENSIFICATION APPROACHES BASED ON A LARGE, MULTI-INSTITUTIONAL SERIES Francesco Barletta, Giancarlo Marra, Jonathan Oliver, Josias Bastian Grogg, Thomas Hermanns, Luca Afferi, Agostino Mattei, Bartosz Malkiewicz, Alessandro Antonelli, Fabio Zattoni, Fabrizio Dal Moro, Roderick van den Bergh, Pawel Rajwa, Shahrok F. Shariat, Xavier Cathelineau, Rossella Nicoletta, Riccardo Campi, Mohamed Ahmed, R. Jeffrey Karnes, Isabel Heidegger, Francesco Montorsi, Paolo Gontero, Alberto Briganti, and Giorgio Gandaglia Francesco BarlettaFrancesco Barletta , Giancarlo MarraGiancarlo Marra , Jonathan OliverJonathan Oliver , Josias Bastian GroggJosias Bastian Grogg , Thomas HermannsThomas Hermanns , Luca AfferiLuca Afferi , Agostino MatteiAgostino Mattei , Bartosz MalkiewiczBartosz Malkiewicz , Alessandro AntonelliAlessandro Antonelli , Fabio ZattoniFabio Zattoni , Fabrizio Dal MoroFabrizio Dal Moro , Roderick van den BerghRoderick van den Bergh , Pawel RajwaPawel Rajwa , Shahrok F. ShariatShahrok F. Shariat , Xavier CathelineauXavier Cathelineau , Rossella NicolettaRossella Nicoletta , Riccardo CampiRiccardo Campi , Mohamed AhmedMohamed Ahmed , R. Jeffrey KarnesR. Jeffrey Karnes , Isabel HeideggerIsabel Heidegger , Francesco MontorsiFrancesco Montorsi , Paolo GonteroPaolo Gontero , Alberto BrigantiAlberto Briganti , and Giorgio GandagliaGiorgio Gandaglia View All Author Informationhttps://doi.org/10.1097/01.JU.0001008808.16085.aa.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Optimal timing of postoperative radiotherapy (RT) remains a controversial topic in radical prostatectomy (RP) prostate cancer (PCa) patients. Randomized trials suggest that early salvage RT (eSRT) is not inferior to adjuvant RT (aRT). Although retrospective evidence supports a survival benefit associated with aRT in pN1 patients, given the heterogeneous prognosis of pN1 disease, only few of these patients might benefit from adjuvant RT. METHODS: We analyzed 751 pN1 PCa patients treated with RP and extended pelvic lymph node dissection at 19 centers from 2006 to 2021. Patients with detectable PSA after surgery and those receiving neoadjuvant therapies were excluded. We selected patients who received early SRT, defined as RT administered at PSA ≤0.5 ng/ml. Multivariable Cox regression (MCR) models were used to assess the impact of pathological characteristics (i.e., pT, ISUP GG at RP, and the number of positive nodes) on overall mortality (OM). A score was assigned to each pathological feature according to MCR coefficients. Patients were then stratified into low (0-2 points), intermediate (4-6), and high (>6) risk groups. The discrimination between groups was tested using c-index. Kaplan-Meier (KM) plots depicted overall survival rates. After 3 months of landmark analysis, MCR models tested for the impact of aRT within each risk group. Here, adjustment variables consisted of androgen-deprivation therapy (ADT) use (none vs. adjuvant ADT vs. salvage ADT). RESULTS: The median age and PSA were 65 years (IQR 60-69) and 10 ng/ml (IQR 6-18). Overall, 318 (43%) patients received aRT. In MCR models, >2 positive lymph nodes represented the strongest predictor for OM (HR: 3.4, 95% CI: 1.8-6.6, p<0.001). After stratification according to MCR scores, 197 (26%) vs. 336 (45%) vs. 218 (29%) were included in the low, intermediate, and high-risk groups. This stratification scheme exhibited good discrimination (c-index: 76%). The 7-year OS rates, according to aRT vs. observation±eSRT, were 100% vs. 92%, 89% vs. 89%, and 84% vs. 73% in the low, intermediate, and high-risk groups, respectively. After landmark analysis, aRT independently predicted lower OM (HR: 0.37, 95% CI: 0.14-0.93, p=0.03) only within the high-risk group. CONCLUSIONS: Among RP pN1 PCa patients, we identified three risk groups based on OM risk. When assessing the impact of aRT vs. observation±eSRT on OM, only high-risk patients seemed to benefit from immediate RT after surgery. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1212 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Francesco Barletta More articles by this author Giancarlo Marra More articles by this author Jonathan Oliver More articles by this author Josias Bastian Grogg More articles by this author Thomas Hermanns More articles by this author Luca Afferi More articles by this author Agostino Mattei More articles by this author Bartosz Malkiewicz More articles by this author Alessandro Antonelli More articles by this author Fabio Zattoni More articles by this author Fabrizio Dal Moro More articles by this author Roderick van den Bergh More articles by this author Pawel Rajwa More articles by this author Shahrok F. Shariat More articles by this author Xavier Cathelineau More articles by this author Rossella Nicoletta More articles by this author Riccardo Campi More articles by this author Mohamed Ahmed More articles by this author R. Jeffrey Karnes More articles by this author Isabel Heidegger More articles by this author Francesco Montorsi More articles by this author Paolo Gontero More articles by this author Alberto Briganti More articles by this author Giorgio Gandaglia More articles by this author Expand All Advertisement PDF downloadLoading ...