'Will I need radiotherapy after my surgery?' Working towards quantitative prediction of salvage radiotherapy post-robotic radical prostatectomy, using prospective clinical, radiological and pathological data
BAUS ePoster online library. Withington J. 06/21/21; 319065; p2-7
Disclosure(s): Nil to disclose
Mr. John Withington
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Abstract
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Introduction
Robotic radical prostatectomy (RARP) is a standalone therapeutic modality with curative intent. Whereas salvage radiotherapy is often regarded as failure of surgery, in fact it functions as an added therapeutic factor. Its frequency can be determined in different patient groups using clinical, radiological and pathological data. We analysed prospectively collected data from a single surgeon series of RARPs.
Materials & Methods
Data from patients undergoing RARP between 2015 and 2020, with a minimum of 12 months' follow up were analysed. Descriptive statistical analysis was conducted, and relative risk was calculated for selected variables of interest.
(See table).
Results
802 cases were reviewed; 800 were included for analysis, minimum follow-up of 35 months. Median age at surgery 62.5; median PSA at presentation 7.0; at radiotherapy, 0.08. Overall, 17.1% (n = 134) required salvage radiotherapy, after a median interval of 14.5 months.
On surgical histopathology, positive margins were associated with a relative risk increase of 2.45 (95% CI 1.81, 3.33; p<0.01) and lymphovascular invasion with a relative risk increase of 3.50 (95% CI 2.62, 4.67; p<0.01).
Conclusion
Analysis of these data have allowed us to precisely advise our patients on the likelihood that they will need salvage radiotherapy after radical prostatectomy. This enables optimally informed conversations both before and after surgery, and appropriately personalised expectation setting and optimism for cure. As functions of disease, not surgery, it is reasonable to expect these results to be generalisable.
Robotic radical prostatectomy (RARP) is a standalone therapeutic modality with curative intent. Whereas salvage radiotherapy is often regarded as failure of surgery, in fact it functions as an added therapeutic factor. Its frequency can be determined in different patient groups using clinical, radiological and pathological data. We analysed prospectively collected data from a single surgeon series of RARPs.
Materials & Methods
Data from patients undergoing RARP between 2015 and 2020, with a minimum of 12 months' follow up were analysed. Descriptive statistical analysis was conducted, and relative risk was calculated for selected variables of interest.
(See table).
Results
802 cases were reviewed; 800 were included for analysis, minimum follow-up of 35 months. Median age at surgery 62.5; median PSA at presentation 7.0; at radiotherapy, 0.08. Overall, 17.1% (n = 134) required salvage radiotherapy, after a median interval of 14.5 months.
On surgical histopathology, positive margins were associated with a relative risk increase of 2.45 (95% CI 1.81, 3.33; p<0.01) and lymphovascular invasion with a relative risk increase of 3.50 (95% CI 2.62, 4.67; p<0.01).
Conclusion
Analysis of these data have allowed us to precisely advise our patients on the likelihood that they will need salvage radiotherapy after radical prostatectomy. This enables optimally informed conversations both before and after surgery, and appropriately personalised expectation setting and optimism for cure. As functions of disease, not surgery, it is reasonable to expect these results to be generalisable.
Introduction
Robotic radical prostatectomy (RARP) is a standalone therapeutic modality with curative intent. Whereas salvage radiotherapy is often regarded as failure of surgery, in fact it functions as an added therapeutic factor. Its frequency can be determined in different patient groups using clinical, radiological and pathological data. We analysed prospectively collected data from a single surgeon series of RARPs.
Materials & Methods
Data from patients undergoing RARP between 2015 and 2020, with a minimum of 12 months' follow up were analysed. Descriptive statistical analysis was conducted, and relative risk was calculated for selected variables of interest.
(See table).
Results
802 cases were reviewed; 800 were included for analysis, minimum follow-up of 35 months. Median age at surgery 62.5; median PSA at presentation 7.0; at radiotherapy, 0.08. Overall, 17.1% (n = 134) required salvage radiotherapy, after a median interval of 14.5 months.
On surgical histopathology, positive margins were associated with a relative risk increase of 2.45 (95% CI 1.81, 3.33; p<0.01) and lymphovascular invasion with a relative risk increase of 3.50 (95% CI 2.62, 4.67; p<0.01).
Conclusion
Analysis of these data have allowed us to precisely advise our patients on the likelihood that they will need salvage radiotherapy after radical prostatectomy. This enables optimally informed conversations both before and after surgery, and appropriately personalised expectation setting and optimism for cure. As functions of disease, not surgery, it is reasonable to expect these results to be generalisable.
Robotic radical prostatectomy (RARP) is a standalone therapeutic modality with curative intent. Whereas salvage radiotherapy is often regarded as failure of surgery, in fact it functions as an added therapeutic factor. Its frequency can be determined in different patient groups using clinical, radiological and pathological data. We analysed prospectively collected data from a single surgeon series of RARPs.
Materials & Methods
Data from patients undergoing RARP between 2015 and 2020, with a minimum of 12 months' follow up were analysed. Descriptive statistical analysis was conducted, and relative risk was calculated for selected variables of interest.
(See table).
Results
802 cases were reviewed; 800 were included for analysis, minimum follow-up of 35 months. Median age at surgery 62.5; median PSA at presentation 7.0; at radiotherapy, 0.08. Overall, 17.1% (n = 134) required salvage radiotherapy, after a median interval of 14.5 months.
On surgical histopathology, positive margins were associated with a relative risk increase of 2.45 (95% CI 1.81, 3.33; p<0.01) and lymphovascular invasion with a relative risk increase of 3.50 (95% CI 2.62, 4.67; p<0.01).
Conclusion
Analysis of these data have allowed us to precisely advise our patients on the likelihood that they will need salvage radiotherapy after radical prostatectomy. This enables optimally informed conversations both before and after surgery, and appropriately personalised expectation setting and optimism for cure. As functions of disease, not surgery, it is reasonable to expect these results to be generalisable.
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