For patients with high risk prostate cancer, is there data to support increased morbidity, such as increased urethral strictures or cystitis, when given postprostatectomy XRT as opposed to definitive XRT?
In general how do you counsel patients with high risk prostate cancer when choosing radiation verse prostatectomy? What numbers do you quote for OS and BCFS?
Answer from: Radiation Oncologist at Academic Institution
This is a very relevant question that commonly comes up in practice - should a man with high risk prostate cancer have a prostatectomy, when the chance of him needing post-op RT is reasonably high, if he could have RT/ADT only and possibly avoid the risks associated with surgery? The discussion must...
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Answer from: Radiation Oncologist at Academic Institution
One needs to take the SWOG data with a grain of salt since those patients who received RT were probably followed by both urologists and radiation oncologists and there may have been more reporting of events in the group who received adjuvant RT. One might consider the followup to be slightly biased...
Answer from: Radiation Oncologist at Academic Institution
I would add this retrospective series from our institution published by Hunter et al in 2013 that reported modern outcomes of IMRT/IGRT in both the definitive and post-operative setting: http://www.ncbi.nlm.nih.gov/pubmed/24674405While this study is of course neither prospective nor randomized, it d...
Answer from: Radiation Oncologist at Community Practice
Perhaps we can extrapolate from the SWOG 8794 data that postprostatectomy XRT has a 18% rate of urethral stricture so that while we can potentially salvage high risk prostatectomy failures with radiation, the complications are worse then if they recieved radiation definitively upfront. Any thoughts?...