Adjuvant versus salvage radiotherapy in prostate cancer: multi-institutional retrospective analysis of the Spanish RECAP database

Purpose To compare adjuvant radiotherapy (ART) to salvage radiotherapy (SRT) after radical prostatectomy (RP) in a cohort of prostate cancer (PCa) patients. The primary aim was to comparatively assess 2- and 5-year biochemical relapse-free survival (BRFS). A secondary aim was to identify predictors of survival. Patients and methods Data were acquired from the RECAP database, a population-based prostate cancer registry in Spain. Inclusion criteria included RP (with or without lymphadenectomy) followed by ART or SRT. A total of 702 patients were analyzed. Pre-RT PSA values (>0.5 vs. ≤0.5 ng/ml), pathological stage (T1–2 vs. T3–4), post-surgical Gleason score (≤7 vs. 8–10), margin status (positive vs. negative), hormonal treatment (yes vs. no), and RT dose (≤66 Gy vs. >66 Gy) were evaluated to assess their impact on BRFS. Results The mean patient age in the ART and SRT groups, respectively, was 64 years (range 42–82) and 64.8 years (range 42–82). Median follow-up after RT in the whole sample was 34 months (range 3–141). A total of 702 patients were included: 223 (31.8%) received ART and 479 (68.2%) SRT. BRFS rates (95% CI) in the ART and SRT groups at months 24 and 60 were, respectively: 98.1% (95.9–100.0%) vs. 91.2% (88.2–94.2%) and 84.5% (76.4–92.6%) vs. 74.0% (67.4–80.7%) ( p = 0.004). No significant differences in OS were observed ( p = 0.053). The following variables were significant predictors of biochemical recurrence in the SRT group: (1) positive surgical margin status ( p = 0.049); (2) no hormonotherapy ( p = 0.03); (3) total prostate dose ≤66 Gy ( p = 0.004); and pre-RT PSA ≥0.5 ng/ml ( p = 0.013). Conclusions This is the first nationwide study in Spain to evaluate a large cohort of PCa patients treated with RP followed by postoperative RT. ART yielded better 2- and 5-year BRFS rates, although OS was equivalent. These findings are consistent with most other published studies and support ART in patients with adverse prognostic characteristics after radical prostatectomy. Prospective trials are needed to compare immediate ART to early SRT to better determine their relative benefits.