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Study underscores increased risks associated with RT after radical prostatectomy

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"Patients and providers should be aware of the long-term risks of radiation exposure when weighing treatment decisions,” says Avi Baskin, MD, MPhil.

Radiation treatment (RT) following radical prostatectomy (RP) was shown to increase the risk of cystitis and worsen long-term general health measures among patients with prostate cancer.1

In total, 9.1% of patients included in the study underwent external beam radiation therapy (EBRT) 5 years following RP.

In total, 9.1% of patients included in the study underwent external beam radiation therapy (EBRT) 5 years following RP.

The findings were published in Urologic Oncology.

"In a large multi-institutional dataset, compared [with] radical prostatectomy alone, those who underwent adjuvant or salvage radiotherapy were more likely to have cystitis during a mean follow up of 7 years. There were no differences between the groups for the [gastrointestinal] GI toxicity, urinary stricture, or incontinence requiring a urologic procedure. Patients and providers should be aware of the long-term risks of radiation exposure when weighing treatment decisions,” said lead author Avi Baskin, MD, MPhil, in correspondence with Urology Times®. Baskin is a urology resident at the University of California, San Francisco (UCSF) School of Medicine.

For the study, investigators collected data from the UCSF Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) on 6258 men who had received a diagnosis of prostate cancer and underwent RP. The investigators measured postoperative complications such as cystitis, GI toxicity, incontinence that required a surgical procedure, ureteral injury, and urinary stricture. Health-related quality of life (HRQOL) outcomes were also assessed using the SF-36 General Health score, as well as scores related to UCSF prostate cancer index complications in urinary function (UF), bowel function (BF), and sexual function (SF).

In total, 9.1% of patients included in the study underwent external beam radiation therapy (EBRT) 5 years following RP. The median duration of EBRT was 1.7 years, and 52% of patients who underwent EBRT received androgen deprivation therapy (ADT). The median follow-up after RP was 86 months (IQR, 44-156) among all patients.

Data showed a total complication rate of 9.3% after RP, with urinary stricture (4.9%) being the most common. The incidence of post-operative cystitis was the second most common at 2.3%.

Patients who underwent RT were at an increased risk of cystitis compared with patients who did not undergo RT (HR, 5.60; 95% CI, 3.40-9.22; P < .01). RT was not associated with other complications measured.

Further, receipt of postoperative RT was also associated with worse general health scores, even after adjustments were made for complications of incontinence, urinary stricture, GI toxicity, or ureteral injury and independent of whether patients experienced those complications. Scores for UF, BF, and SF showed no difference between patients who underwent RT after RP and patients who underwent RP alone.

Poorer general health scores were observed among patients who experienced cystitis, GI toxicity, and urinary stricture (all P < .01). Better UF scores were observed for patients with an incontinence procedure or urinary stricture (both P < .01).

The authors concluded, “[Although] post-operative RT is the only curative option for [prostate cancer] after RP, patients and providers should be aware of the increased risks when making treatment decisions.”

Reference

1. Baskin A, Cowan JE, Braun A, et al. Long-term complications and health-related quality of life outcomes after radical prostatectomy with or without subsequent radiation treatment for prostate cancer. Urol Oncol. [Published online ahead of print July 3, 2023.] Accessed August 4, 2023. doi:10.1016/j.urolonc.2023.06.003

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