Adjuvant or immediate external irradiation after radical prostatectomy with pelvic lymph node dissection for high-risk prostate cancer: A multidisciplinary decision

摘要

Abdollah et al. selected, from a cohort of 6357 patients who underwent radical prostatectomy with extended pelvic lymph node dissection in the same institution between 1988 and 2008, a series of 1049 patients with pathologically advanced prostate cancer (PCa). The aim was to evaluate the impact of risk prognostic factors on survival with a regression analysis, and then to evaluate the relationship between adjuvant radiotherapy (ART) and survival according to the number of selected risk factors. The adjuvant treatments were based on the clinical judgment of each treating physician according to clinical and cancer characteristics after discussion with the patient. The following distribution was noted: no treatment (n = 370), ART (n = 243), ART plus androgen deprivation therapy (ADT)(n = 288), andADT alone (n = 148). In all, only pathologic Gleason score >8, pT3b/T4 stage, and positive lymph node count >1 (pN1) were independent predictors of cancer-specific mortality (p < 0.02). The cumulative number of these predictive factors was used to develop a risk score and ranged from zero to three, with the following breakdown: zero (43.6%), one (22.1 %), two (20.7%), and three (13.6%); only patients with a risk score >2 benefited from ART with lower cancer-specific mortality and overall mortality rates (p = 0.006).