Use of post-surgical radiation for prostate cancer patients at risk of recurrence is declining, despite known benefit

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Oftentimes, after a prostatectomy, (surgical removal of the prostate), if the cancer recurs men may undergo radiation, especially if they are at a high-risk for recurrence. However, a new study is showing this treatment path is declining in the US, despite its known benefit. 

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The study was published in the journal, European Urology. Researchers found fewer than 10% of patients at risk of recurrence receive post-surgery radiotherapy within six months of surgery.

  • In 30% of patients, prostate cancer will recur
  • For patients with more aggressive cancers, 60-70% may experience a recurrence

3 large randomized clinical trials

  • 2 in Europe, 1 in US
  • Showed post-surgery radiation in patients with adverse pathological features reduces risk of PSA recurrence
  • Also may prevent need for ADT (androgen deprivation therapy)
  • May reduce metastasis and improve survival
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  • US Study: American Cancer Society and Massachusetts General Hospital 
    • Patients who received radiation after RP decreased steadily between 2005-2011
    • Radiation therapy was used more in younger patients and those at high risk but use rates were still low with fewer than 20%

Study authors say decline could be due to:

  • Patient preference
  • Physician bias
  • Concern for toxicity
  • Lack of consistent survival benefit seen in updated randomized trials
  • Growing preference for salvage radiation (used in weeks post-surgery is PSA rises)