European Association of Urology Biochemical Recurrence Risk Classification as a Decision Tool for Salvage Radiotherapy-A Multicenter Study.

Autor: Preisser F; Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Frankfurt, Frankfurt, Germany., Abrams-Pompe RS; Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany., Stelwagen PJ; Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands., Böhmer D; Department of Radiation Oncology, Charité University Hospital, Berlin, Germany., Zattoni F; Department of Surgery, Oncology and Gastroenterology, Urology Clinic, University of Padova, Padova, Italy., Magli A; Department of Radiation Oncology, University Hospital of Udine, ASUIUD, Udine, Italy; Department of Radiation Oncology, Hospital San Martino, Belluno, Italy., Rivas JG; Department of Urology, Clinico San Carlos Hospital, Madrid, Spain., Dilme RV; Department of Urology, Clinico San Carlos Hospital, Madrid, Spain., Sepulcri M; Radiation Oncology Unit, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy., Eguibar A; Department of Urology, La Paz University Hospital, Madrid, Spain., Heidegger I; Department of Urology, Medical University Innsbruck, Innsbruck, Austria., Arnold C; Department of Therapeutic Radiology and Oncology, Medical University Innsbruck, Innsbruck, Austria., Fankhauser CD; Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland; Department of Urology, University Zurich, Zurich, Switzerland., Chun FK; Department of Urology, University Hospital Frankfurt, Frankfurt, Germany., van der Poel H; Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands., Gandaglia G; Department of Urology, Urological Research Institute, Vita-Salute University and San Raffaele Hospital, Milan, Italy., Wiegel T; Department of Radiotherapy and Radiooncology, University Hospital Ulm, Ulm, Germany., van den Bergh RCN; Department of Urology, Antonius Hospital, Utrecht, The Netherlands., Tilki D; Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, Koc University Hospital, Istanbul, Turkey. Electronic address: d.tilki@uke.de.
Jazyk: angličtina
Zdroj: European urology [Eur Urol] 2024 Feb; Vol. 85 (2), pp. 164-170. Date of Electronic Publication: 2023 Jun 22.
DOI: 10.1016/j.eururo.2023.05.038
Abstrakt: Background: The European Association of Urology (EAU) has proposed a risk stratification for patients harboring biochemical recurrence (BCR) after radical prostatectomy (RP).
Objective: To assess whether this risk stratification helps in choosing patients for salvage radiotherapy (SRT).
Design, Setting, and Participants: Analyses of 2379 patients who developed BCR after RP (1989-2020), within ten European high-volume centers, were conducted. Early and late SRT were defined as SRT delivered at prostate-specific antigen values <0.5 and ≥0.5 ng/ml, respectively.
Outcome Measurements and Statistical Analysis: Multivariable Cox models tested the effect of SRT versus no SRT on death and cancer-specific death. The Simon-Makuch method tested for survival differences within each risk group.
Results and Limitations: Overall, 805 and 1574 patients were classified as having EAU low- and high-risk BCR. The median follow-up was 54 mo after BCR for survivors. For low-risk BCR, 12-yr overall survival was 87% versus 78% (p = 0.2) and cancer-specific survival was 100% versus 96% (p = 0.2) for early versus no SRT. For high-risk BCR, 12-yr overall survival was 81% versus 66% (p < 0.001) and cancer-specific survival was 98% versus 82% (p < 0.001) for early versus no SRT. In multivariable analyses, early SRT decreased the risk for death (hazard ratio [HR]: 0.55, p < 0.01) and cancer-specific death (HR: 0.08, p < 0.001). Late SRT was a predictor of cancer-specific death (HR: 0.17, p < 0.01) but not death (p = 0.1).
Conclusions: Improved survival was recorded within the high-risk BCR group for patients treated with early SRT compared with those under observation. Our results suggest recommending early SRT for high-risk BCR men. Conversely, surveillance might be suitable for low-risk BCR, since only nine patients with low-risk BCR died from prostate cancer during follow-up.
Patient Summary: The impact of salvage radiotherapy (SRT) on cancer-specific outcomes stratified according to the European Association of Urology biochemical recurrence (BCR) risk classification was assessed. While men with high-risk BCR should be offered SRT, surveillance might be a suitable option for those with low-risk BCR.
(Copyright © 2023 European Association of Urology. Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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