Reply from authors re: Michel Bolla. Adjuvant or immediate external irradiation after radical prostatectomy with pelvic lymph node dissection for high-risk prostate cancer: A multidisciplinary decision. Eur Urol 2013;63:1009-10

摘要

We read with great interest the comments by Dr. Bolla about our recently published article. We totally agree that the retrospective nature of our cohort implied several limitations, such as the lack of pathologic review and of standardized adjuvant treatment protocols. Such confoun-ders certainly may be a source of biases. However, one might argue that the lack of a systematic, centralized pathologic review and the consequent potential heterogeneity in Gleason grading attribution among institutions might also influence long-term analyses of previous protracted multicenter prospective randomized trials. These variations over time might partially undermine the applicability of such results to contemporary patients. Nevertheless, there is no dispute that randomized studies do remain the main pillars of evidence-based medicine. However, retrospective reports, including our study, certainly can be considered hypothesis generating, and they definitely warrant consideration for the design of future prospective randomized trials. Let us give an example. The long-term results of the European Organisation for Research and Treatment of Cancer (EORTC) study randomizing men with pNO, Rl, and/or pT3 disease to either adjuvant radiotherapy (ART) or observation did not show any difference in favor of ART in terms of patient survival. However, such disappointing results are actually not surprising based on currently available data evaluating the long-term survival of patients treated with radical prostatectomy (RP). For example, a 60-yr-old patient with pT3a disease and Gleason score 4 + 3, treated with RP alone, has approximately a 3% risk of dying of prostate cancer (PCa) at 15 yr, even in the presence of positive surgical margins. For the same patient with pT2 disease and positive surgical margins, the risk of dying of PCa is virtually nil even at 20 yr after surgery.