Low Use of Immediate and Delayed Postoperative Radiation for Prostate Cancer with Adverse Pathological Features

Level 1 evidence supports immediate radiation in post-prostatectomy patients with adverse pathological features while analogous evidence for delayed radiation is lacking. We evaluated immediate and delayed radiation practice patterns and identified factors affecting their use.

Using the National Cancer Data Base we identified 57,448 men diagnosed with pT3 disease and/or positive margins from 2004 to 2009. Postoperative radiation use through 2011 was analyzed by time trends and multivariate analysis.

A total of 4,316 men (7.5%) received immediate radiation, 1,637 (2.8%) received delayed radiation and 51,495 (90%) were observed. Immediate and delayed radiation use remained relatively stable except for a small but significant decrease in immediate radiation in 2008. This decrease was associated with a relative increase in delayed radiotherapy. Compared to 2004 men diagnosed in 2007 to 2009 had 1.3-fold to 1.5-fold higher odds of delayed radiation than of immediate radiation (p <0.01). The strongest predictors of immediate radiation were margin status, T stage, N stage, Gleason score and patient age. Men with positive margins, seminal vesicle invasion, nodal disease, or Gleason score 8 or greater and younger men had 2.3-fold to sixfold greater odds of receiving immediate radiation than observation (p <0.01). Men with positive margins, seminal vesicle invasion or nodal metastases were also more likely to receive immediate rather than delayed radiation (p <0.01).

Post-prostatectomy radiation is performed sparingly. Immediate radiation rates remain low but do not appear to be influenced substantially by delayed radiation use. Consistent with the evidence, patients at high risk for recurrence are more likely to undergo immediate radiation rather than observation or delayed radiation.