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2008
UPDATE: "Adjuvant Radiotherapy for pT3 Prostate Cancer: Results of a
Randomized Prospective Clinical Trial" (SWOG 8794)
(June 2008)
At the recent AUA
meeting this abstract presentation reported that at the longer median
follow-up of 11.5 years, adjuvant radiotherapy for high-risk patients
after prostatectomy significantly improved metastases-free survival and
overall survival as opposed to a strategy of initial observation. The
earlier report (JAMA, Nov. 2006), with a median follow-up of 10.6 years,
was reviewed in the May/June 2008 PCa Commentary and had documented
prolongation of freedom from PSA relapse, decrease in local failure, and
a delay in subsequent androgen deprivation therapy for those men who
received radiation - and these benefits were confirmed in this longer
follow-up.
The new findings in
the 2008 update: The "significantly improved metastasis free survival"
(p=0.053) resulted in a 15-year estimate of freedom from
metastases of 46% for men treated with adjuvant radiation versus
38% for initial observation. With the longer follow-up the benefit in
overall survival for radiation gained significance: 47%
versus 37%, projected to 15 years.
As expected, at 6
months and 2 years radiation was associated with significant increases
in patient-reported GU-specific symptoms and adverse health-related
quality of life issues compared to initial observation, but these
differences "disappeared by 5 years."
The collaborators in
this study concluded: "All patients with pT3 prostate cancer should be
given the option of radiation therapy."
[For a review of the
2006 report on SWOG 8794 see PCa Commentary indexed under "Adjuvant and
Salvage TX for Primary TX Failure.]
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