When cancer is confined to the prostate, removal of the organ can successfully control the disease. However, for patients with cancer extending beyond the prostate the risk of recurrence after surgery can be 10-50%.
Michel Bolla (CHUA Michallon, Grenoble, France) and colleagues tested whether immediate radiotherapy after surgical removal of the prostate (prostatectomy) improved progression-free survival for patients at risk of relapse. Between 1992 to 2001, the investigators recruited 1000 patients who had undergone radical prostatectomy from 37 centres in Europe. Half were assigned to radiotherapy after surgery and half to monitoring. After a 5-year follow-up the researchers found that 74% of patients in the radiotherapy group had biochemical progression-free survival compared with 53% in the monitored group. Biochemical progression-free survival refers to the patient's concentration of prostate-specific antigen--a marker for prostate cancer. They investigators also found that clinical progression-free survival was significantly improved in the radiotherapy group.
Professor Bolla concludes: "Our results show significant improvement in biochemical progression-free survival with immediate postoperative irradiation...Long-term follow-up is needed to assess if postoperative irradiation affects the occurrence of distant metastases, survival, or both."
In an accompanying comment Stefan Hocht (Charité University Hospital, Berlin, Germany) states: "Michel Bolla and colleagues report on a large study from the European Organisation for Research and Treatment of Cancer (EORTC) that is likely to change patterns of care in locally advanced prostate cancer...Although the superiority of adjuvant radiotherapy is to be expected, we did not have direct proof of this hypothesis. The question still to be answered is whether adjuvant irradiation is superior to early salvage treatment as soon as prostate-specific antigen rises."
Professor Michel Bolla, CHUA Michallon, Radiation department, BP 217X, F-38043, Grenoble Cedex, France.
Dr Stefan Hocht, Dept. Radiation Oncology and Radiotherapy, Charité University Hospital, Campus Benjamin Franklin, D-12200 Berlin, Germany