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Radiotherapy following prostatectomy does not impact survival in patients with node-positive prostate cancer
Joshua R. Kaplan, M.D.1, Keith J. Kowalczyk, M.D.2, Tudor Borza, M.D.1, Xiangmei Gu, M.S.3, Stuart R. Lipsitz, Sc.D.3, Paul L. Nguyen, M.D.4, David F. Friedlander, B.S.5, Jim C. Hu, M.D., M.P.H.6.
1Division of Urologic Surgery, Brigham and Women’s/Faulkner Hospital, Harvard Medical School, Boston, MA, USA, 2Department of Urology, Georgetown University Hospital, Washington, DC, USA, 3Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA, 4Department of Radiation Oncology, Lank Center for Genitourinary Oncology, Dana Farber Cancer Institute, Boston, MA, USA, 5Harvard University School of Public Health, Boston, MA, USA, 6Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.

BACKGROUND:
It is unknown whether adjuvant radiation therapy (ART) improves outcomes in men with lymph node positive prostate cancer (LNPC) after radical prostatectomy (RP). Using a population-based approach, we assessed the impact of ART in men with LNPC.
METHODS:
Surveillance, Epidemiology, and End Results (SEER)-Medicare linked data was used to identify 577 men with LNPC following RP from 1995-2007. We further identified those who did (n=177) and did not (n=400) receive postoperative ART within one year of surgery. All men with metastatic disease other than lymph node involvement were excluded. Using propensity-score methods, we compared overall mortality, prostate cancer-specific mortality, and bone-related events (bone metastasis and/or pathologic fracture) between men receiving and not receiving postoperative ART.
RESULTS:
Men receiving postoperative ART had higher rates of androgen deprivation therapy (ADT) utilization. There was no significant differences in overall mortality, prostate cancer-specific mortality, or bone-related events between groups (Table 1). However, among men with pT4 disease, ART was associated with a lower risk of bone-related events (0.98 vs. 7.85 events per 100 person-years, p=0.039).
Table 1. Outcomes of ART vs. no-ART (events per 100 person-years).
Before Propensity WeightingAfter Propensity Weighting
No ART (N=400)ART (N=177)P-valueNo ARTARTP-value
OM3.734.870.1323.765.090.153
PCSM1.262.340.0711.282.830.090
Bone-related events4.094.240.8624.134.200.945
CONCLUSIONS:
Using a population-based model, we demonstrate that post-RP ART in men with LNPC does not improve overall or disease specific survival. While ART does not appear to protect against the overall likelihood of bone-related events in the setting of node-positive disease, ART may reduce bone-related events in men with T4 disease.


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