Concern for overtreatment using the AUA/ASTRO guideline on adjuvant radiotherapy after radical prostatectomy
Recently, three prospective randomized trials have shown that adjuvant radiotherapy (ART) after radical prostatectomy for the patients with pT3 and/or positive margins improves biochemical progression-free survival and local recurrence free survival. But, the optimal management of these patients aft...
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| Veröffentlicht in: | BMC urology 2014-04, Vol.14 (1), p.30-30, Article 30 |
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| creator | Kang, Jung Hun Ha, Yun-Sok Kim, Sung Yu, Jihyeong Patel, Neal Parihar, Jaspreet S Salmasi, Amirali Hassanzadeh Kim, Wun-Jae Kim, Isaac Yi |
| description | Recently, three prospective randomized trials have shown that adjuvant radiotherapy (ART) after radical prostatectomy for the patients with pT3 and/or positive margins improves biochemical progression-free survival and local recurrence free survival. But, the optimal management of these patients after radical prostatectomy is an issue which has been debated continuously. The object of this study was to determine the necessity of adjuvant radiotherapy (ART) by reviewing the outcomes of observation without ART after radical prostatectomy (RP) in patients with pathologic indications for ART according to the American Urological Association (AUA)/American Society for Radiation Oncology (ASTRO) guideline.
From a prospectively maintained database, 163 patients were eligible for inclusion in this study. These men had a pathological stage pT2-3 N0 with undetectable PSA level after RP and met one or more of the three following risk factors: capsular perforation, positive surgical margins, or seminal vesicle invasion. We excluded the patients who had received neoadjuvant hormonal therapy or adjuvant treatment, or had less than 24 months of follow-up. To determine the factors that influenced biochemical recurrence-free (BCR), univariate and multivariate Cox proportional hazards analyses were performed.
Among the 163 patients, median follow-up was 50.5 months (24.0-88.2 months). Of those men under observation, 27 patients had BCR and received salvage radiotherapy (SRT). The multivariate Cox analysis showed that BCR was marginally associated with pre-operative serum PSA (P = 0.082), and the pathologic GS (HR, 4.063; P = 0.001) was an independent predictor of BCR. More importantly, in 87 patients with pre-operative PSA < 6.35 ng/ml and GS ≤ 7, only 3 developed BCR.
Of the 163 patients who qualified for ART based on the current AUA/ASTRO guideline, only 27 (16.6%) developed BCR and received SRT. Therefore, using ART following RP using the current recommendation may be an overtreatment in an overwhelming majority of the patients. |
| doi_str_mv | 10.1186/1471-2490-14-30 |
| format | Article |
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From a prospectively maintained database, 163 patients were eligible for inclusion in this study. These men had a pathological stage pT2-3 N0 with undetectable PSA level after RP and met one or more of the three following risk factors: capsular perforation, positive surgical margins, or seminal vesicle invasion. We excluded the patients who had received neoadjuvant hormonal therapy or adjuvant treatment, or had less than 24 months of follow-up. To determine the factors that influenced biochemical recurrence-free (BCR), univariate and multivariate Cox proportional hazards analyses were performed.
Among the 163 patients, median follow-up was 50.5 months (24.0-88.2 months). Of those men under observation, 27 patients had BCR and received salvage radiotherapy (SRT). The multivariate Cox analysis showed that BCR was marginally associated with pre-operative serum PSA (P = 0.082), and the pathologic GS (HR, 4.063; P = 0.001) was an independent predictor of BCR. More importantly, in 87 patients with pre-operative PSA < 6.35 ng/ml and GS ≤ 7, only 3 developed BCR.
Of the 163 patients who qualified for ART based on the current AUA/ASTRO guideline, only 27 (16.6%) developed BCR and received SRT. Therefore, using ART following RP using the current recommendation may be an overtreatment in an overwhelming majority of the patients.</description><identifier>ISSN: 1471-2490</identifier><identifier>EISSN: 1471-2490</identifier><identifier>DOI: 10.1186/1471-2490-14-30</identifier><identifier>PMID: 24708639</identifier><language>eng</language><publisher>England: BioMed Central Ltd</publisher><subject>Adult ; Aged ; Analysis ; Cancer therapies ; Confidence intervals ; Drug dosages ; Evidence-Based Medicine ; Guideline Adherence - utilization ; Health aspects ; Health Services Misuse - prevention & control ; Health Services Misuse - statistics & numerical data ; Humans ; Male ; Medical Oncology - standards ; Medicine ; Men ; Middle Aged ; Oncology ; Practice Guidelines as Topic ; Practice Patterns, Physicians' - standards ; Practice Patterns, Physicians' - statistics & numerical data ; Prostate cancer ; Prostatectomy - standards ; Prostatic Neoplasms - therapy ; Radiation ; Radiation therapy ; Radiotherapy ; Radiotherapy, Adjuvant - standards ; Retrospective Studies ; Statistical analysis ; Studies ; United States ; University colleges ; Urology</subject><ispartof>BMC urology, 2014-04, Vol.14 (1), p.30-30, Article 30</ispartof><rights>COPYRIGHT 2014 BioMed Central Ltd.</rights><rights>2014 Kang et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.</rights><rights>Copyright © 2014 Kang et al.; licensee BioMed Central Ltd. 2014 Kang et al.; licensee BioMed Central Ltd.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b613t-600bb85af647ce2cf3c9e8663ed14747459b6d12bc33ec8b13096a1b54ff98863</citedby><cites>FETCH-LOGICAL-b613t-600bb85af647ce2cf3c9e8663ed14747459b6d12bc33ec8b13096a1b54ff98863</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4005471/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4005471/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,315,728,781,785,865,886,27929,27930,53796,53798</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24708639$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kang, Jung Hun</creatorcontrib><creatorcontrib>Ha, Yun-Sok</creatorcontrib><creatorcontrib>Kim, Sung</creatorcontrib><creatorcontrib>Yu, Jihyeong</creatorcontrib><creatorcontrib>Patel, Neal</creatorcontrib><creatorcontrib>Parihar, Jaspreet S</creatorcontrib><creatorcontrib>Salmasi, Amirali Hassanzadeh</creatorcontrib><creatorcontrib>Kim, Wun-Jae</creatorcontrib><creatorcontrib>Kim, Isaac Yi</creatorcontrib><title>Concern for overtreatment using the AUA/ASTRO guideline on adjuvant radiotherapy after radical prostatectomy</title><title>BMC urology</title><addtitle>BMC Urol</addtitle><description>Recently, three prospective randomized trials have shown that adjuvant radiotherapy (ART) after radical prostatectomy for the patients with pT3 and/or positive margins improves biochemical progression-free survival and local recurrence free survival. But, the optimal management of these patients after radical prostatectomy is an issue which has been debated continuously. The object of this study was to determine the necessity of adjuvant radiotherapy (ART) by reviewing the outcomes of observation without ART after radical prostatectomy (RP) in patients with pathologic indications for ART according to the American Urological Association (AUA)/American Society for Radiation Oncology (ASTRO) guideline.
From a prospectively maintained database, 163 patients were eligible for inclusion in this study. These men had a pathological stage pT2-3 N0 with undetectable PSA level after RP and met one or more of the three following risk factors: capsular perforation, positive surgical margins, or seminal vesicle invasion. We excluded the patients who had received neoadjuvant hormonal therapy or adjuvant treatment, or had less than 24 months of follow-up. To determine the factors that influenced biochemical recurrence-free (BCR), univariate and multivariate Cox proportional hazards analyses were performed.
Among the 163 patients, median follow-up was 50.5 months (24.0-88.2 months). Of those men under observation, 27 patients had BCR and received salvage radiotherapy (SRT). The multivariate Cox analysis showed that BCR was marginally associated with pre-operative serum PSA (P = 0.082), and the pathologic GS (HR, 4.063; P = 0.001) was an independent predictor of BCR. More importantly, in 87 patients with pre-operative PSA < 6.35 ng/ml and GS ≤ 7, only 3 developed BCR.
Of the 163 patients who qualified for ART based on the current AUA/ASTRO guideline, only 27 (16.6%) developed BCR and received SRT. Therefore, using ART following RP using the current recommendation may be an overtreatment in an overwhelming majority of the patients.</description><subject>Adult</subject><subject>Aged</subject><subject>Analysis</subject><subject>Cancer therapies</subject><subject>Confidence intervals</subject><subject>Drug dosages</subject><subject>Evidence-Based Medicine</subject><subject>Guideline Adherence - utilization</subject><subject>Health aspects</subject><subject>Health Services Misuse - prevention & control</subject><subject>Health Services Misuse - statistics & numerical data</subject><subject>Humans</subject><subject>Male</subject><subject>Medical Oncology - standards</subject><subject>Medicine</subject><subject>Men</subject><subject>Middle Aged</subject><subject>Oncology</subject><subject>Practice Guidelines as Topic</subject><subject>Practice Patterns, Physicians' - standards</subject><subject>Practice Patterns, Physicians' - statistics & numerical data</subject><subject>Prostate cancer</subject><subject>Prostatectomy - standards</subject><subject>Prostatic Neoplasms - therapy</subject><subject>Radiation</subject><subject>Radiation therapy</subject><subject>Radiotherapy</subject><subject>Radiotherapy, Adjuvant - standards</subject><subject>Retrospective Studies</subject><subject>Statistical analysis</subject><subject>Studies</subject><subject>United States</subject><subject>University colleges</subject><subject>Urology</subject><issn>1471-2490</issn><issn>1471-2490</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNp1Uk1r4zAQFUuX7dee97YIenYjWbZiXxbcsNsWCoV-nIUkj1IFW0plOZB_X6Vp0wa6zEHDzJvHm6dB6Bcl55RWfEKLKc3yoiYZLTJGvqGjXeXgU36IjodhQQidViX_gQ7zYkoqzuoj1M280xAcNj5gv4IQA8jYg4t4HKyb4_gEuHlsJs39w90tno-2hc46wN5h2S7GlUzIIFvrEzDI5RpLEyG8lrTs8DL4IcoIOvp-fYq-G9kN8PPtPUGP__4-zK6ym9vL61lzkylOWcw4IUpVpTS8mGrItWG6hopzBm3aKEVZK97SXGnGQFeKMlJzSVVZGFNXaa8T9GfLuxxVD61O2wTZiWWwvQxr4aUV-x1nn8Tcr0RBSJk8SwQXWwJl_X8I9jva92Ljtti4nTLBSCI5e1MR_PMIQxQLPwaXFhe0zElelJzQD9RcdiCsMz4R6t4OWjQlq3le52yDOv8ClaKF3mrvwNhU3xuYbAd0-oAhgNmJp0lfOp0v5P7-bNoO_34r7AXr8b-M</recordid><startdate>20140407</startdate><enddate>20140407</enddate><creator>Kang, Jung Hun</creator><creator>Ha, Yun-Sok</creator><creator>Kim, Sung</creator><creator>Yu, Jihyeong</creator><creator>Patel, Neal</creator><creator>Parihar, Jaspreet S</creator><creator>Salmasi, Amirali Hassanzadeh</creator><creator>Kim, Wun-Jae</creator><creator>Kim, Isaac Yi</creator><general>BioMed Central Ltd</general><general>BioMed Central</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QP</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>5PM</scope></search><sort><creationdate>20140407</creationdate><title>Concern for overtreatment using the AUA/ASTRO guideline on adjuvant radiotherapy after radical prostatectomy</title><author>Kang, Jung Hun ; Ha, Yun-Sok ; Kim, Sung ; Yu, Jihyeong ; Patel, Neal ; Parihar, Jaspreet S ; Salmasi, Amirali Hassanzadeh ; Kim, Wun-Jae ; Kim, Isaac Yi</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b613t-600bb85af647ce2cf3c9e8663ed14747459b6d12bc33ec8b13096a1b54ff98863</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Analysis</topic><topic>Cancer therapies</topic><topic>Confidence intervals</topic><topic>Drug dosages</topic><topic>Evidence-Based Medicine</topic><topic>Guideline Adherence - utilization</topic><topic>Health aspects</topic><topic>Health Services Misuse - prevention & control</topic><topic>Health Services Misuse - statistics & numerical data</topic><topic>Humans</topic><topic>Male</topic><topic>Medical Oncology - standards</topic><topic>Medicine</topic><topic>Men</topic><topic>Middle Aged</topic><topic>Oncology</topic><topic>Practice Guidelines as Topic</topic><topic>Practice Patterns, Physicians' - standards</topic><topic>Practice Patterns, Physicians' - statistics & numerical data</topic><topic>Prostate cancer</topic><topic>Prostatectomy - standards</topic><topic>Prostatic Neoplasms - therapy</topic><topic>Radiation</topic><topic>Radiation therapy</topic><topic>Radiotherapy</topic><topic>Radiotherapy, Adjuvant - standards</topic><topic>Retrospective Studies</topic><topic>Statistical analysis</topic><topic>Studies</topic><topic>United States</topic><topic>University colleges</topic><topic>Urology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kang, Jung Hun</creatorcontrib><creatorcontrib>Ha, Yun-Sok</creatorcontrib><creatorcontrib>Kim, Sung</creatorcontrib><creatorcontrib>Yu, Jihyeong</creatorcontrib><creatorcontrib>Patel, Neal</creatorcontrib><creatorcontrib>Parihar, Jaspreet S</creatorcontrib><creatorcontrib>Salmasi, Amirali Hassanzadeh</creatorcontrib><creatorcontrib>Kim, Wun-Jae</creatorcontrib><creatorcontrib>Kim, Isaac Yi</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>BMC urology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kang, Jung Hun</au><au>Ha, Yun-Sok</au><au>Kim, Sung</au><au>Yu, Jihyeong</au><au>Patel, Neal</au><au>Parihar, Jaspreet S</au><au>Salmasi, Amirali Hassanzadeh</au><au>Kim, Wun-Jae</au><au>Kim, Isaac Yi</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Concern for overtreatment using the AUA/ASTRO guideline on adjuvant radiotherapy after radical prostatectomy</atitle><jtitle>BMC urology</jtitle><addtitle>BMC Urol</addtitle><date>2014-04-07</date><risdate>2014</risdate><volume>14</volume><issue>1</issue><spage>30</spage><epage>30</epage><pages>30-30</pages><artnum>30</artnum><issn>1471-2490</issn><eissn>1471-2490</eissn><abstract>Recently, three prospective randomized trials have shown that adjuvant radiotherapy (ART) after radical prostatectomy for the patients with pT3 and/or positive margins improves biochemical progression-free survival and local recurrence free survival. But, the optimal management of these patients after radical prostatectomy is an issue which has been debated continuously. The object of this study was to determine the necessity of adjuvant radiotherapy (ART) by reviewing the outcomes of observation without ART after radical prostatectomy (RP) in patients with pathologic indications for ART according to the American Urological Association (AUA)/American Society for Radiation Oncology (ASTRO) guideline.
From a prospectively maintained database, 163 patients were eligible for inclusion in this study. These men had a pathological stage pT2-3 N0 with undetectable PSA level after RP and met one or more of the three following risk factors: capsular perforation, positive surgical margins, or seminal vesicle invasion. We excluded the patients who had received neoadjuvant hormonal therapy or adjuvant treatment, or had less than 24 months of follow-up. To determine the factors that influenced biochemical recurrence-free (BCR), univariate and multivariate Cox proportional hazards analyses were performed.
Among the 163 patients, median follow-up was 50.5 months (24.0-88.2 months). Of those men under observation, 27 patients had BCR and received salvage radiotherapy (SRT). The multivariate Cox analysis showed that BCR was marginally associated with pre-operative serum PSA (P = 0.082), and the pathologic GS (HR, 4.063; P = 0.001) was an independent predictor of BCR. More importantly, in 87 patients with pre-operative PSA < 6.35 ng/ml and GS ≤ 7, only 3 developed BCR.
Of the 163 patients who qualified for ART based on the current AUA/ASTRO guideline, only 27 (16.6%) developed BCR and received SRT. Therefore, using ART following RP using the current recommendation may be an overtreatment in an overwhelming majority of the patients.</abstract><cop>England</cop><pub>BioMed Central Ltd</pub><pmid>24708639</pmid><doi>10.1186/1471-2490-14-30</doi><tpages>1</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Aged Analysis Cancer therapies Confidence intervals Drug dosages Evidence-Based Medicine Guideline Adherence - utilization Health aspects Health Services Misuse - prevention & control Health Services Misuse - statistics & numerical data Humans Male Medical Oncology - standards Medicine Men Middle Aged Oncology Practice Guidelines as Topic Practice Patterns, Physicians' - standards Practice Patterns, Physicians' - statistics & numerical data Prostate cancer Prostatectomy - standards Prostatic Neoplasms - therapy Radiation Radiation therapy Radiotherapy Radiotherapy, Adjuvant - standards Retrospective Studies Statistical analysis Studies United States University colleges Urology |
| title | Concern for overtreatment using the AUA/ASTRO guideline on adjuvant radiotherapy after radical prostatectomy |
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