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Sources of Funding: none

Introduction

Studies have shown that adjuvant radiation therapy (ART) decreases biochemical recurrence after radical prostatectomy in men with adverse features. Guidelines recommend including these patients in a shared decision making (SDM) discussion about the risk and benefits of ART. Despite possible benefits, ART is not commonly prescribed. Our objective is to understand the relationship between adverse features and referral to Radiation Oncology (RO) in high-risk patients who had a SDM discussion with their urologist.

Methods

Pathologic data was prospectively collected at a single site on all radical prostatectomy specimens from 2009-2015. Patients with adverse features were selected, defined as positive surgical margins (SM), extraprostatic extension (EPE), and seminal vesicle invasion (SVI). All patients had a negative 3-month postoperative PSA. Chart review recorded ART discussion in the notes, explicit recommendation for ART, referral to RO for ART, receipt of ART, and if a patient was referred for salvage therapy. Univariable logistic regression analysis for each individual adverse feature was performed, and a second analysis for patients with 2 or more features.

Results

200 patients had any adverse feature. ART was discussed in 131 (66%) and recommended to 46 (23%). Thirty-nine patients (19.5%) had a consultation with RO for ART, 24 (12%) underwent ART, and 30 (15%) were referred for salvage therapy. The likelihood of recommendation for ART was 6.7%, 14.3%, 20%, and 52% for SM, EPE, SVI, and 2 or more risk factors, respectively. Odds ratios are presented in Table 1.

Conclusions

To our knowledge, this is the first study to examine how adverse features influence referral for ART after a SDM discussion after prostatectomy. In our study, ART was discussed with the majority of patients but an explicit recommendation was underutilized. A single individual adverse feature negatively correlated to recommendation, whereas multiple adverse features were strongly associated with referral.

Funding

none