Login to Access Video or Poster Abstract: MP05-02
Sources of Funding: none

Introduction

Level one evidence and current NCCN guidelines recommend adjuvant radiotherapy (ART) for patients with adverse pathologic features following radical prostatectomy. Salvage radiotherapy (SRT) administered upon detection of biochemical recurrence may be an appropriate alternative limiting overutilization of radiotherapy in the majority and cost?effective. We sought to describe our outcomes using salvage radiotherapy.

Methods

A total of 1,269 consecutive patients diagnosed with localized prostate cancer who underwent robot?assisted radical prostatectomy (RARP) from 2002 to 2013 were included. Biochemical recurrence was defined as 0.2 ng/mL or greater on 2 consecutive visits following surgery. Primary outcomes included BCR, prostate cancer specific mortality (PCSM), and overall mortality (OM). Cost estimates for radiotherapy administered were calculated based on 2016 Medicare reimbursement rates.

Results

Of the 1,269 men who underwent RARP at median follow?up of 5.0 years, 227 (17.9%) men had BCR. According to NCCN guidelines, ART was recommended to 436 (34.4%). Of these eligible patients, 273 (62.6%) had no ART with no subsequent BCR; 84% had follow?up exceeding 2 years. The remaining 163 (37.4%) men did have BCR of which 32 (2.5%) received ART concurrent with androgen deprivation therapy. The remaining had salvage therapy including 27 (2.1%) with SRT alone (Table 1). Overall and PCSM was 59 (4.7%) and 18 (1.4%), respectively. Medicare expense for ART is $37,130.85. Following NCCN guidelines would equate to an additional $10 million in radiotherapy costs in men with no subsequent BCR. Given >80% in this NCCN ART group with no evidence of disease 2+ years, the risk of further progression in the ART group is minimal (<10%).

Conclusions

For men with adverse pathologic features the risk of overtreatment with ART ranged from 67?85%. These outcomes are consistent with prior reports suggesting utilization of SRT may be more cost effective and have comparable outcomes to ART. These results support current clinical trials underway discerning the utility of SRT in men with adverse pathologic features.

Funding

none