Re: Impact of Adjuvant Radiation Therapy on Urinary Continence Recovery after Radical Prostatectomy

available at http://jurology.com/ Editorial Comment: The SWOG (Southwest Oncology Group) randomized trial of adjuvant radiotherapy for high risk prostate cancer managed by radical prostatectomy demonstrated improved survival among treated men with only a modest effect on urinary control. This retrospective evaluation of prospectively recorded data shows a profound effect of adjuvant radiotherapy on recovery of urinary control by 3 years. In this series recovery of control is defined as no pad use, and standardized instruments are not used. Additionally the effect of more radical surgery in high risk cases must be considered as adding to recovery of control, although use of radiation remains significant on multivariate analysis. Samir S. Taneja, M.D. 1. Thompson IM, Tangen CM, Paradelo J et al: Adjuvant radiotherapy for pathological T3N0M0 prostate cancer significantly reduces risk of metastases and improves survival: long-term followup of a randomized clinical trial. J Urol 2009; 181: 956. Re: Postoperative Radiotherapy After Radical Prostatectomy for High-Risk Prostate Cancer: Long-Term Results of a Randomised Controlled Trial (EORTC Trial 22911) M. Bolla, H. van Poppel, B. Tombal, K. Vekemans, L. Da Pozzo, T. M. de Reijke, A. Verbaeys, J. F. Bosset, R. van Velthoven, M. Colombel, C. van de Beek, P. Verhagen, A. van den Bergh, C. Sternberg, T. Gasser, G. van Tienhoven, P. Scalliet, K. Haustermans and L. Collette; European Organisation for Research and Treatment of Cancer, Radiation Oncology and Genito-Urinary Groups Department of Radiation Oncology, Centre Hospitalier Universitaire A Michallon, Grenoble, France Lancet 2012; 380: 2018–2027. Abstract available at http://jurology.com/ Editorial Comment: In this updated report of the outcomes of the EORTC (European Organization for the Research and Treatment of Cancer) randomized trial of adjuvant radiotherapy following radical prostatectomy the authors demonstrate a decrease in biochemical relapse but no improvement in metastasis-free, cancer specific or overall survival. This result is contrary to the findings of the parallel SWOG (Southwest Oncology Group) trial, in which adjuvant radiotherapy was shown notavailable at http://jurology.com/ Editorial Comment: In this updated report of the outcomes of the EORTC (European Organization for the Research and Treatment of Cancer) randomized trial of adjuvant radiotherapy following radical prostatectomy the authors demonstrate a decrease in biochemical relapse but no improvement in metastasis-free, cancer specific or overall survival. This result is contrary to the findings of the parallel SWOG (Southwest Oncology Group) trial, in which adjuvant radiotherapy was shown not TESTIS CANCER AND ADVANCES IN ONCOLOGIC THERAPY 111 only to decrease biochemical recurrence, but also to improve overall survival, despite the fact that the studies are remarkably similar. Grade 2 genitourinary toxicity was greater among men undergoing radiation. Interestingly on subset analysis men older than 70 years and those with negative margins appear to have a greater mortality risk if radiated. As these are predominantly noncancer deaths, the effect may be related to the radiation, although the mechanism is unclear. As only a third of the patients in the “wait and see” group underwent salvage radiotherapy at relapse, the study cannot be used to compare adjuvant and early salvage radiotherapy. This may be the most clinically relevant question. Given the potential toxicity of therapy, I continue to selectively offer adjuvant radiotherapy only to those men in whom I perceive the rate of treatment failure and subsequent cancer mortality to be high based on pathological evaluation. In these men multimodal approaches are warranted. For the majority of men with Gleason score less than 8 and pT3 disease with or without a positive margin I offer early salvage at biochemical relapse. Samir S. Taneja, M.D.