Adjuvant Radiation Therapy vs Initial Observation for Patients After Prostatectomy With Adverse Pathology: Have...

Area of Science:

• Urology
• Oncology
• Clinical Trials

Background:

• Three randomized clinical trials (RCTs) established initial observation as standard for adverse pathology (AP) after radical prostatectomy (RP).
• The 2020 publication of these RCTs provided level-one evidence supporting observation over early salvage radiotherapy.

Purpose of the Study:

• To assess the trend in adjuvant radiotherapy (aRT) utilization post-radical prostatectomy (RP).
• To determine if aRT use has decreased following the 2020 publication of key RCTs on adverse pathology (AP).

Main Methods:

• Retrospective review of the Michigan Urological Surgery Improvement Collaborative prostate cancer registry (2012-2024).
• Analysis of patients undergoing RP with specific inclusion criteria (post-operative PSA ≤0.1, AP: pT3a/pT3b/pT4 and/or positive surgical margins).
• Comparison of aRT rates across time periods: pre-2020, 2020, and post-2020, using Kaplan-Meier and Cox regression.

Main Results:

• A total of 9,144 patients met the inclusion criteria.
• Adjuvant radiotherapy (aRT) use decreased from 8.2% pre-2020 to 4.6% in 2020 and 2.7% post-2020.
• Multivariable analysis confirmed a significant decrease in aRT use after 2020 (OR 0.24, p<0.001).

Conclusions:

• The utilization of adjuvant radiotherapy (aRT) has decreased following the 2020 publication of pivotal RCTs.
• This trend supports the current evidence favoring initial observation for patients with adverse pathology (AP) after radical prostatectomy (RP).