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External beam radiation therapy after radical prostatectomy: efficacy and impact on urinary continence

Prostate Cancer and Prostatic Diseases volume 7, pages 170–177 (2004)Cite this article

Abstract

Introduction and Objectives: The efficacy of adjuvant and salvage external beam radiation (AXRT+SXRT) for prostate cancer after radical prostatectomy (RP) has been debated because of the inability to rule out systemic occult metastasis, uncertainty that radiation eradicates residual local disease and the potential of exacerbating impotency and incontinence. To characterize the effectiveness and treatment morbidity a retrospective review was performed.

Methods: In all, 38 patients received AXRT and 91 received SXRT. The SXRT group was stratified by PSA level, age, race, pathologic stage, margin status, worst Gleason sum, radiation dose and pelvic field. Complications evaluated were impotence and incontinence. Median follow-up was 60.2 months.

Results: The 5-y disease-free survival (DFS) rate was 61.3% for AXRT and 36.3% for SXRT. Multivariate analysis of the SXRT cohort showed Gleason score, pathologic stage and pre-XRT PSA to be predictors of disease recurrence. After XRT 26% had worsened continence.

Conclusions: Patients who recur after RP whose pathologic stage is pT2 or pT3c, Gleason score of 8 or higher or pre-XRT PSA is >2.0 ng/dl may have microscopic metastatic disease and a decreased chance of cure with SXRT alone. Continence was further impaired after XRT.

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Acknowledgements

This research was supported by the following: The Center for Prostate Disease Research, a program of the Henry M Jackson Foundation for the Advancement of Military Medicine, 1401 Rockville Pike, Suite 600, Rockville, MD 20852-3001, funded by the US Army Medical Research and Materiel Command. This research was approved through the Department of Clinical Investigation, Walter Reed Army Medical Center, Washington, DC, WU# 2857-98 and WU#2852-98.

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Authors and Affiliations

  1. Center for Prostate Disease Research (CPDR), Rockville, Maryland, USA

    R A Petroski, J Herring, L Sun, C V Smith, R R Connelly, D G McLeod & J W Moul

  2. Department of Surgery, Urology Service, Walter Reed Army Medical Center, Washington, DC, USA

    R A Petroski, C V Smith, D G McLeod & J W Moul

  3. Division of Radiation Oncology, Department of Radiology, Walter Reed Army Medical Center, Washington, DC, USA

    W B Warlick

  4. Department of Surgery, Uniformed Services University of the Health Science, Bethesda, Maryland, USA

    J Herring, L Sun & D G McLeod

  5. Division of Urology, National Naval Medical Center, Bethesda, Maryland, USA

    J Herring, T F Donahue & J W Moul

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  1. R A Petroski
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  2. W B Warlick
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  4. T F Donahue
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  7. R R Connelly
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Correspondence to J W Moul.

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The opinions and assertions contained herein are the private views of the authors and are not to be construed as reflecting the views of the US Army or the Department of Defense.

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Petroski, R., Warlick, W., Herring, J. et al. External beam radiation therapy after radical prostatectomy: efficacy and impact on urinary continence. Prostate Cancer Prostatic Dis 7, 170–177 (2004). https://doi.org/10.1038/sj.pcan.4500718

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  • DOI: https://doi.org/10.1038/sj.pcan.4500718

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