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Published on: March 6, 2018
Influence of Adverse Pathologic Features on Potential Benefit of Hormone Therapy Use with Postoperative Radiotherapy
Amar U Kishan1, Yilun Sun2, Christopher C Parker3
1Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA, USA.
European Urology
|July 28, 2026
Summary
Adverse pathological features are prognostic but do not predict hormonal therapy benefit after prostate cancer radiotherapy. This finding is crucial for patients with pre-radiotherapy PSA ≤0.5 ng/ml.
Area of Science:
- Oncology
- Clinical Trials
- Prostate Cancer Research
Background:
- A prior meta-analysis showed limited survival benefit from adding hormonal therapy (HT) to postoperative radiotherapy for prostate cancer.
- This benefit was observed in patients with pre-radiotherapy prostate-specific antigen (PSA) ≤0.5 ng/ml.
- The impact of adverse pathological features on this benefit was unclear.
Purpose of the Study:
- To investigate if the benefit of adding HT to postoperative radiotherapy is modified by the number of adverse pathological features (AFC).
- To evaluate the prognostic and predictive value of AFC for overall survival (OS) and metastasis-free survival (MFS).
Main Methods:
- Individual patient data (IPD) from five randomized phase 3 trials were analyzed.
- Adverse feature count (AFC) was defined as the sum of grade group 4-5 disease, seminal vesicle invasion, positive surgical margins, and extracapsular extension (0-4).
- Intention-to-treat meta-analytical models were used to assess interactions.
Main Results:
- AFC was independently prognostic for OS and MFS in 4781 patients.
- AFC did not significantly modify the OS benefit of HT (interaction HR 0.93, p=0.4).
- AFC did not significantly modify the MFS benefit of HT (interaction HR 0.88, p=0.08).
Conclusions:
- Adverse pathological features are prognostic for outcomes in prostate cancer patients treated with radiotherapy.
- These features do not appear to predict the benefit of adding hormonal therapy.
- Findings are relevant for optimizing treatment decisions in patients with pre-radiation PSA ≤0.5 ng/ml.