Even though strong evidence and guidelines back the use of post-surgical radiation therapy for prostate cancer patients susceptible to recurrence, fewer patients are undergoing the treatment, according to a study published online in the journal European Urology.
Radical prostatectomy (RP) is frequently used to treat localized prostate cancer but about 30 percent of patients who undergo that treatment develop biochemical recurrence following surgery. In addition, 60 to 70 percent of patients with more aggressive cancers may experience biochemical recurrence.
But three large, randomized prospective clinical trials have shown that postoperative radiotherapy (RT) reduces the risk of prostate-specific antigen recurrence. The American Society for Radiation Oncology and American Urological Association recommend offering adjuvant RT to patients with “adverse pathologic features” present during surgery.
Researchers from the American Cancer Society and Massachusetts General Hospital evaluated data from the National Cancer Data Base, which included a total of 97,270 patients between ages 18 and 79 who were diagnosed between 2005 and 2011.
They found that from 2005 to 2011, the number of patients who received RT after RP decreased from 9.1 percent to 7.3 percent. Furthermore, fewer than 10 percent of the patients at risk of recurrence received RT within six months of surgery.
The researchers believes that RT use is declining because patients are preferring not to undergo the treatment, physician and referral bias, worry over toxicity, the fact that the updated randomized trials don’t show consistent survival benefits, and an increasing preference for “salvage radiation.”
The researchers think that more needs to be done to guarantee that patients are counseled on their options and the available evidence.
