Use of Radiotherapy After Prostate Cancer Surgery Declining, Despite Evidence of Benefit
Despite strong evidence and guidelines supporting its use, postsurgical radiation therapy for prostate cancer patients at risk of tumor recurrence is declining in the United States. The study, published by Sineshaw et al in European Urology, finds fewer than 10% of patients at risk of tumor recurrence received postoperative radiotherapy within 6 months of surgery.
Widely Recommended Treatment
Although radical prostatectomy is a common curative treatment for localized prostate cancer, about 30% of patients will develop biochemical recurrence after surgery, meaning their prostate-specific antigen (PSA) level will again rise. For some patients with more aggressive cancers, as many as 60% to 70% can experience biochemical recurrence (also called biochemical failure).
Three large randomized prospective clinical trials, two done in Europe and one in the United States, have demonstrated that postoperative radiotherapy in patients with adverse pathologic features reduces the risk of PSA recurrence, may prevent the need for androgen-deprivation therapy, and may reduce metastasis and improve survival.
In the United States, the American Society for Radiation Oncology (ASTRO) and the American Urological Association (AUA) recommend offering adjuvant radiotherapy to patients with adverse pathologic features found at the time of surgery.
Researchers from the American Cancer Society and Massachusetts General Hospital, led by Helmneh Sineshaw, MD, MPH, analyzed data from the National Cancer Data Base (NCDB), a national hospital-based cancer registry database that captures data on approximately 70% of newly diagnosed cancer cases in the United States. The study included 97,270 patients between the ages of 18 and 79 diagnosed between 2005 and 2011.
Study Findings
The data showed that receipt of radiotherapy after radical prostatectomy decreased steadily between 2005 and 2011, from 9.1% to 7.3%. And although radiotherapy use was higher in younger patients and in those at highest risk for tumor recurrence, overall rates of utilization remain low, with fewer than 20% of patients in subgroups most likely to benefit receiving radiotherapy.
The authors say declining utilization of radiotherapy could be due to multiple factors, including patient preference; physician and referral bias; concern for toxicity; lack of a consistent survival benefit seen in the updated randomized trials; or a growing preference for “salvage radiation,” done if a patient's PSA rises in the weeks and months after surgery.
Nonetheless, the authors say additional effort is needed to ensure patients are counseled regarding their options and available evidence. “The declining trend in the utilization of postoperative radiotherapy calls for the attention of clinicians to make appropriate referrals to radiation oncologists or clinical oncologists when appropriate,” they wrote.
Dr. Sineshaw is the corresponding author of the European Urology article.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
