The new Guidelines discuss the ART vs SRT issue for those men who choose surgery and have positive local node(s); however, I don't see the ART vs SRT discussion for high- and very high-risk men with other adverse pathology (e.g., SM, SVI) revealed by surgery. The three recent studies that will probably sway the pendulum from ART to early SRT for most men suffered the usual problem of having relatively small numbers of Gleason 9-10 men, since very-high Gleason scores are much less common. The studies I've seen conclude that too few G9-10 men with adverse post-op pathology get advised adjuvant therapy.A meta-analysis on the use of radiotherapy after prostatectomy: adjuvant versus early salvage radiation
(Review, Full Text, June 2022)
To determine which method of radiotherapy proves more effective after prostatectomy: Adjuvant (ART) or early salvage (ESRT), we observed the pathologic and adverse risk factors of patients and their results from both treatments, looking specifically at biochemical-free survival rates, metastasis-free survival rates, and overall survival rates. Peer review articles containing their own data collected between 1986 and 2022 were reviewed. We reviewed 67 peer review articles and included 33 that met criteria. Studies focused on the adverse risk factors and the results of patients either before/after receiving adjuvant or early salvage/salvage radiotherapy were included in the analysis. Patient characteristics had an effect on what treatment a patient would receive; if a patient had more than one adverse risk factor such as a high Gleason score, prostate-specific antigen (PSA) level, T-stage, or positive margins, they would receive immediate radiation after prostatectomy, which would classify as ART. If the patient had no adverse risk factors after surgery, they would be placed in an observation period to follow their PSA and overall health, and only if necessary, undergo ESRT. Of the 33 studies, ART was proven to be only slightly more beneficial when relating to biochemical recurrence-free survival while ART and ESRT results were similar in metastasis-free survival and overall survival. ART and ESRT are overall comparable in their patient outcomes, despite their own unique pros and cons. The use of ESRT reduces overtreatment in men who may not experience biochemical recurrence. However, in those with very high-risk pathologic features, a multi-disciplinary approach should be utilized to best determine which mode of radiation therapy after surgery is recommended.
Post Edited (DjinTonic) : 5/14/2022 9:20:47 AM (GMT-6)