Postoperative radiotherapy for high-risk prostate cancer

摘要

Contrary to the published conclusions, the results of the EORTC study by Michel Bolla and colleagues (Dec 8, p 2018)1 seem to provide evidence that postoperative radiation for high-risk early-stage prostate cancer does not provide a clinically meaningful benefit. The improvement in biochemical progression-free survival is only of benefit to patients if it correlates with an improved prostate-cancer-specific or overall survival or if it relieves symptoms and improves quality of life. Although the immediate postoperative radiation given to patients in this study did reduce locoregional relapse from 16-6% to 7-3%, there are no data about how many of these patients had symptomatic relapses or whether the radiation improved quality-of-life scores. More significantly, the immediate radiation did not improve prostate-specific or overall survival at a median of 10-6 years, nor did it reduce the cumulative rates of distant metastases or improve clinical progression-free survival. Additionally, the immediate radiation was associated with increased grade 3 toxicity (5-3% vs 2-5%), more grade 2 or higher genitourinary toxicity (21-3% vs 13-5%), and more late effects of any grade (70-8% vs 59-7%).