In patients with local prostate cancer and high risk features (extension to surgical margins, seminal vesicles or prostate capsule), adjuvant radiotherapy after prostatectomy appears to improve overall survival and reduce the rate of distant metastases, but these effects are only evident with longer follow up.
The quality of evidence is downgraded by study limitations (selective outcome reporting).
A Cochrane review 1 included 3 studies with a total of 1815 patients, assessing the effect of adjuvant radiotherapy (RT) following radical prostatectomy (RP) in prostate cancer. Patients were at increased risk of relapse due to extension of disease to seminal vesicles, prostate capsule or surgical margins.
Adjuvant RT following RP did not affect overall survival (OS) at 5 years (RD (risk difference) 0.00; 95% CI -0.03 to 0.03), but improved survival at 10 years (RD -0.11; 95% CI -0.20 to -0.02). Adjuvant RT did not reduce metastatic disease at 5 years (RD -0.00; 95% CI -0.04 to 0.03), but reduced it at 10 years (RD -0.11; 95% CI -0.20 to -0.01). It improved local control at 5 and 10 years (RD -0.10; 95% CI -0.13 to -0.06 and RD -0.14; 95% CI -0.21 to -0.07, respectively), and biochemical progression-free survival at 5 years and 10 years (RD -0.16; 95% CI -0.21 to -0.11 and RD -0.29; 95% CI -0.39 to -0.19, respectively).
1. Daly T, Hickey BE, Lehman M et al. Adjuvant radiotherapy following radical prostatectomy for prostate cancer. Cochrane Database Syst Rev 2011;(12):CD007234. [PMID:22161411]
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"Adjuvant Radiotherapy Following Radical Prostatectomy for Prostate Cancer With High Risk Characteristics." Evidence-Based Medicine Guidelines, Duodecim Medical Publications Limited, 2019. Evidence Central, evidence.unboundmedicine.com/evidence/view/EBMG/457545/all/Adjuvant_radiotherapy_following_radical_prostatectomy_for_prostate_cancer_with_high_risk_characteristics.
Adjuvant radiotherapy following radical prostatectomy for prostate cancer with high risk characteristics. Evidence-Based Medicine Guidelines. Duodecim Medical Publications Limited; 2019. https://evidence.unboundmedicine.com/evidence/view/EBMG/457545/all/Adjuvant_radiotherapy_following_radical_prostatectomy_for_prostate_cancer_with_high_risk_characteristics. Accessed May 11, 2021.
Adjuvant radiotherapy following radical prostatectomy for prostate cancer with high risk characteristics. (2019). In Evidence-Based Medicine Guidelines. Duodecim Medical Publications Limited. https://evidence.unboundmedicine.com/evidence/view/EBMG/457545/all/Adjuvant_radiotherapy_following_radical_prostatectomy_for_prostate_cancer_with_high_risk_characteristics
Adjuvant Radiotherapy Following Radical Prostatectomy for Prostate Cancer With High Risk Characteristics [Internet]. In: Evidence-Based Medicine Guidelines. Duodecim Medical Publications Limited; 2019. [cited 2021 May 11]. Available from: https://evidence.unboundmedicine.com/evidence/view/EBMG/457545/all/Adjuvant_radiotherapy_following_radical_prostatectomy_for_prostate_cancer_with_high_risk_characteristics.
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