Post-RP radiation therapy on decline in U.S.

Post-radical prostatectomy radiation therapy in patients at risk of prostate cancer recurrence is on the wane in the U.S., despite evidence and guidelines supporting the practice, recently published research indicates.

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The study, which was published online in European Urology (April 17, 2015), found that fewer than 10% of patients at risk of recurrence received postoperative radiotherapy (RT) within 6 months of surgery in the U.S, according to a press release from the American Cancer Society, Atlanta.

Three large randomized prospective clinical trials have demonstrated that postoperative RT in patients with adverse pathologic features reduces risk of PSA recurrence, may prevent the need for androgen deprivation therapy, and may reduce metastasis and improve survival.

In the United States, the AUA and the American Society for Radiation Oncology recommend offering adjuvant RT to patients with adverse pathologic features found at the time of surgery. The two groups collaborated on a guideline regarding use of adjuvant and salvage RT after prostatectomy that was later endorsed by the American Society of Clinical Oncology.

To investigate how available evidences were being implemented, researchers from the American Cancer Society and Massachusetts General Hospital, Boston led by Helmneh Sineshaw, MD, MPH of the American Cancer Society, analyzed data from the National Cancer Data Base, a national hospital-based cancer registry that captures data on approximately 70% of newly diagnosed cancer cases in the U.S. The study included 97,270 patients between the ages of 18 and 79 years diagnosed between 2005 and 2011.

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The data showed that receipt of post-prostatectomy RT decreased steadily between 2005 and 2011, from 9.1% to 7.3%. And while RT use was higher in younger patients and in those at highest risk for recurrence, overall rates of utilization remained low, with fewer than 20% of patients in subgroups most likely to benefit receiving RT.

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The authors say declining utilization of RT could be due to multiple factors, including patient preference, physician and referral bias, concern for toxicity, lack of a consistent survival benefit seen in the updated randomized trials, or a growing preference for salvage radiation.

Nonetheless, the authors say additional effort is needed to ensure patients are counseled regarding their options and available evidence.

“The declining trend in the utilization of postoperative RT calls for the attention of clinicians to make appropriate referrals to radiation oncologists or clinical oncologists when appropriate,” they wrote.

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