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Adjuvant Treatment and Follow Up after Radical Prostatectomy in Prostate Cancer

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A Guide to Management of Urological Cancers

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Abstract

Radical prostatectomy is an important treatment option for localised prostate cancer. As many as 30% of these patients do develop biochemical relapse over time. Some of them have high-risk features which are predictors of treatment failure. Giving immediate postoperative radiotherapy (adjuvant radiotherapy) may be an overtreatment for at least 40% of these patients who may not experience failure despite these high-risk features. They will be subjected to unnecessary toxicities of postoperative radiotherapy. Salvage radiotherapy is an approach where we select out the patients who are failing. There is some indication that lymph node-positive patients benefit by adjuvant radiotherapy and long-term hormonal therapy.

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References

  1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209–49. https://doi.org/10.3322/caac.21660.

    Article  PubMed  Google Scholar 

  2. Kumar A, Samavedi S, Mouraviev V, Bates AS, Coelho RF, Rocco B, Patel VR. Predictive factors and oncological outcomes of persistently elevated prostate-specific antigen in patients following robot-assisted radical prostatectomy. J Robot Surg. 2017;11:37–45.

    Article  PubMed  Google Scholar 

  3. Van den Broeck T, et al. Prognostic value of biochemical recurrence following treatment with curative intent for prostate cancer: a systematic review. Eur Urol. 2019;75(6):967–87. https://doi.org/10.1016/j.eururo.2018.10.011.

    Article  PubMed  Google Scholar 

  4. Pagano MJ, Whalen MJ, Paulucci DJ, Reddy BN, Matulay JT, Rothberg M, Scarberry K, Patel T, Shapiro EY, RoyChoudhury A, et al. Predictors of biochemical recurrence in pT3b prostate cancer after radical prostatectomy without adjuvant radiotherapy. Prostate. 2016;76:226–34.

    Article  PubMed  Google Scholar 

  5. Hsu M, Chang SL, Ferrari M, Nolley R, Presti JC Jr, Brooks JD. Length of site-specific positive surgical margins as a risk factor for biochemical recurrence following radical prostatectomy. Int J Urol. 2011;18:272–9.

    Article  PubMed  Google Scholar 

  6. Alkhateeb S, Alibhai S, Fleshner N, Finelli A, Jewett M, Zlotta A, Nesbitt M, Lockwood G, Trachtenberg J. Impact of positive surgical margins after radical prostatectomy differs by disease risk group. J Urol. 2010;183:145–50.

    Article  PubMed  Google Scholar 

  7. Yossepowitch O, Briganti A, Eastham JA, Epstein J, Graefen M, Montironi R, Touijer K. Positive surgical margins after radical prostatectomy: a systematic review and contemporary update. Eur Urol. 2014;65:303–13.

    Article  PubMed  Google Scholar 

  8. Tourinho-Barbosa R, Srougi V, Nunes-Silva I, Baghdadi M, Rembeyo G, Eiffel SS, Barret E, Rozet F, Galiano M, Cathelineau X, Sanchez-Salas R. Biochemical recurrence after radical prostatectomy: what does it mean? Int Braz J Urol. 2018;44(1):14–21.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Amling CL, Bergstralh EJ, Blute ML, Slezak JM, Zincke H. Defining prostate specific antigen progression after radical prostatectomy: what is the most appropriate cut point? J Urol. 2001;165:1146–51.

    Article  CAS  PubMed  Google Scholar 

  10. Heidenreich A, Bastian PJ, Bellmunt J, Bolla M, Joniau S, van der Kwast T, et al. European Association of Urology guidelines on prostate cancer. Part II: treatment of advanced, relapsing, and castration-resistant prostate cancer. Eur Urol. 2014;65:467–79.

    Article  CAS  PubMed  Google Scholar 

  11. Cookson MS, Aus G, Burnett AL, Canby-Hagino ED, D’Amico AV, Dmochowski RR, et al. Variation in the definition of biochemical recurrence in patients treated for localized prostate cancer: the American urological association prostate guidelines for localized prostate cancer update panel report and recommendations for a standard in the reporting of surgical outcomes. J Urol. 2007;177:540–5.

    Article  CAS  PubMed  Google Scholar 

  12. Stephenson AJ, Kattan MW, Eastham JA, Dotan ZA, Bianco FJ Jr, Lilja H, Scardino PT. Defining biochemical recurrence of prostate cancer after radical prostatectomy: a proposal for a standardized definition. J Clin Oncol. 2006;24(24):3973–8.

    Article  CAS  PubMed  Google Scholar 

  13. Thompson IM, Tangen CM, Paradelo J, Lucia MS, Miller G, Troyer D, Messing E, Forman J, Chin J, Swanson G, et al. Adjuvant radiotherapy for pathological T3N0M0 prostate cancer significantly reduces risk of metastases and improves survival: long-term followup of a randomized clinical trial. J Urol. 2009;181:956–62.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Daly T, Hickey BE, Lehman M, Francis DP, See AM. Adjuvant radiotherapy following radical prostatectomy for prostate cancer. Cochrane Database Syst Rev. 2011;12:CD007234.

    Google Scholar 

  15. Parker CC, Clarke NW, Cook AD, Kynaston HG, Petersen PM, Catton C, Cross W, Logue J, Parulekar W, Payne H, et al. Timing of radiotherapy after radical prostatectomy (RADICALS-RT): a randomised, controlled phase 3 trial. Lancet. 2020;396:1413–21.

    Article  CAS  PubMed  Google Scholar 

  16. Sargos P, Chabaud S, Latorzeff I, Magne N, Benyoucef A, Supiot S, Pasquier D, Abdiche MS, Gilliot O, GraffCailleaud P, et al. Adjuvant radiotherapy versus early salvage radiotherapy plus short-term androgen deprivation therapy in men with localised prostate cancer after radical prostatectomy (GETUG-AFU 17): a randomised, phase 3 trial. Lancet Oncol. 2020;21:1341–52.

    Article  CAS  PubMed  Google Scholar 

  17. Kneebone A, Fraser-Browne C, Duchesne GM, Fisher R, Frydenberg M, Herschtal A, Williams SG, Brown C, Delprado W, Haworth A, et al. Adjuvant radiotherapy versus early salvage radiotherapy following radical prostatectomy (TROG 08.03/ANZUP RAVES): a randomised, controlled, phase 3, non-inferiority trial. Lancet Oncol. 2020;21:1331–40.

    Article  CAS  PubMed  Google Scholar 

  18. Van den Broeck T, van den Bergh RCN, Arfi N, et al. Prognostic value of biochemical recurrence following treatment with curative intent for prostate cancer: a systematic review. Eur Urol. 2019;75:967e987.

    Google Scholar 

  19. Pfister D, Bolla M, Briganti A, Carroll P, Cozzarini C, Joniau S, et al. Early salvage radiotherapy following radical prostatectomy. Eur Urol. 2014;65:103443.

    Article  Google Scholar 

  20. Fossati N, Karnes RJ, Cozzarini C, Fiorino C, Gandaglia G, Joniau S, et al. Assessing the optimal timing for early salvage radiation therapy in patients with prostate-specific antigen rise after radical prostatectomy. Eur Urol. 2016;69:728–33. https://doi.org/10.1016/j.eururo.2015.10.009.

    Article  PubMed  Google Scholar 

  21. King CR. Adjuvant radiotherapy after prostatectomy: does waiting for a prostate specific antigen level make sense? Int J Radiat Oncol Biol Phys. 2011;80:1–3.

    Article  PubMed  Google Scholar 

  22. Carrie C, Hasbini A, de Laroche G, Richaud P, Guerif S, Latorzeff I, Supiot S, Bosset M, Lagrange JL, Beckendorf V, Lesaunier F, Dubray B, Wagner JP, N’Guyen TD, Suchaud JP, Créhange G, Barbier N, Habibian M, Ferlay C, Fourneret P, Ruffion A, Dussart S. Salvage radiotherapy with or without short-term hormone therapy for rising prostate-specific antigen concentration after radical prostatectomy (GETUG-AFU 16): a randomised, multicentre, open-label phase 3 trial. Lancet Oncol. 2016;17(6):747–56.

    Article  CAS  PubMed  Google Scholar 

  23. Sargos P, Chabaud S, Latorzeff I, Magné N, Benyoucef A, Supiot S, Pasquier D, Abdiche MS, Gilliot O, Graff-Cailleaud P, Silva M, Bergerot P, Baumann P, Belkacemi Y, Azria D, Brihoum M, Soulié M, Richaud P. Adjuvant radiotherapy versus early salvage radiotherapy plus short-term androgen deprivation therapy in men with localised prostate cancer after radical prostatectomy (GETUG-AFU 17): a randomised, phase 3 trial. Lancet Oncol. 2020;21(10):1341–52.

    Article  CAS  PubMed  Google Scholar 

  24. Shipley WU, Seiferheld W, Lukka HR, Major PP, Heney NM, Grignon DJ, Sartor O, Patel MP, Bahary JP, Zietman AL, Pisansky TM, Zeitzer KL, Lawton CA, Feng FY, Lovett RD, Balogh AG, Souhami L, Rosenthal SA, Kerlin KJ, Dignam JJ, Pugh SL, Sandler HM, NRG Oncology RTOG. Radiation with or without antiandrogen therapy in recurrent prostate cancer. N Engl J Med. 2017;376(5):417–28.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Pollack A, Karrison TG, Balogh AG, Gomella LG, Low DA, Bruner DW, Wefel JS, Martin AG, Michalski JM, Angyalfi SJ, Lukka H, Faria SL, Rodrigues GB, Beauchemin MC, Lee RJ, Seaward SA, Allen AM, Monitto DC, Seiferheld W, Sartor O, Feng F, Sandler HM. The addition of androgen deprivation therapy and pelvic lymph node treatment to prostate bed salvage radiotherapy (NRG oncology/RTOG 0534 SPPORT): an international, multicentre, randomised phase 3 trial. Lancet. 2022;399(10338):1886–901.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Sella T, Schwartz LH, Swindle PW, Onyebuchi CN, Scardino PT, Scher HI, et al. Suspected local recurrence after radical prostatectomy: endorectal coil MR imaging. Radiology. 2004;231(2):379–85. https://doi.org/10.1148/radiol.2312030011.

    Article  PubMed  Google Scholar 

  27. Park JS, Park W, Pyo HR, Park BK, Park SY, Choi HY, et al. Suggestion for the prostatic fossa clinical target volume in adjuvant or salvage radiotherapy after a radical prostatectomy. Radiother Oncol. 2014;110(2):240–4. https://doi.org/10.1016/j.radonc.2014.01.001.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Radiation Oncology, Dr B R Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences (AIIMS), New Delhi, India

    K. P. Haresh & V. R. Anjali

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  1. K. P. Haresh
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  2. V. R. Anjali
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Editors and Affiliations

  1. Department of Urology, All India Institute of Medical Sciences, New Delhi, Delhi, India

    Prabhjot Singh

  2. Department of Urology, All India Institute of Medical Sciences, New Delhi, Delhi, India

    Brusabhanu Nayak

  3. Department of Urology, All India Institute of Medical Sciences, New Delhi, Delhi, India

    Sridhar Panaiyadiyan

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Haresh, K.P., Anjali, V.R. (2023). Adjuvant Treatment and Follow Up after Radical Prostatectomy in Prostate Cancer. In: Singh, P., Nayak, B., Panaiyadiyan, S. (eds) A Guide to Management of Urological Cancers. Springer, Singapore. https://doi.org/10.1007/978-981-99-2341-0_18

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  • DOI: https://doi.org/10.1007/978-981-99-2341-0_18

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  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-99-2340-3

  • Online ISBN: 978-981-99-2341-0

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