Stereotactic or conventional radiotherapy for macroscopic prostate bed recurrence: a propensity score analysis

Area of Science:

• Oncology
• Radiation Oncology
• Urology

Background:

• Prostate cancer recurrence after radical prostatectomy (RP) can be treated with salvage radiation therapy (SRT) with curative intent.
• Macroscopic prostate bed recurrence presents a specific challenge for treatment selection.

Purpose of the Study:

• To compare outcomes between salvage radiation therapy (SRT) and stereotactic radiotherapy for macroscopic prostate recurrence (SSRT) after RP.
• To evaluate efficacy and toxicity using a propensity score-matched analysis.

Main Methods:

• Retrospective collection of data from 185 patients across seven Italian centers treated for macroscopic prostate bed recurrence post-RP.
• Propensity score matching was employed to create comparable treatment cohorts for analysis.

Main Results:

• After matching, 45 patients were analyzed in both the SRT and SSRT groups.
• No significant differences were observed in biochemical (BRFS) or progression-free survival (PFS) between the matched groups (p=0.08 and p=0.8, respectively).
• SSRT showed a significantly lower rate of acute and late gastrointestinal and genitourinary toxicity compared to SRT (p<0.001 for acute GI).

Conclusions:

• Stereotactic radiotherapy for macroscopic prostate recurrence (SSRT) offers comparable efficacy to conventional salvage radiation therapy (SRT).
• SSRT presents a favorable therapeutic ratio with reduced toxicity, positioning it as a compelling alternative treatment.
• The reduced number of fractions in SSRT contributes to its attractiveness as a treatment option.