| Title: |
Real-World Management of High-Risk Prostate Cancer Post-Radical Prostatectomy: Insights from a Regional Quality Collaborative |
| Authors: |
Hochberg, Aaron R.; Ho, Annie H.; Thompson, Rasheed A. M.; Buck, Matthew B.; Lallas, Costas D.; Ibilibor, Christine; Tomaszewski, Jeffrey J.; Ginzburg, Serge; Correa, Andres; Uzzo, Robert; Smaldone, Marc C.; Danella, John F.; Guzzo, Thomas J.; Lee, Daniel J.; Belkoff, Laurence; Walker, Jeffrey; Raman, Jay D.; Clark, Roderick K.; Reese, Adam; Jacobs, Bruce; Jang, Thomas; Kowalczyk, Keith J.; Smith, Meghan; Shah, Mihir S. |
| Source: |
Department of Urology Faculty Papers |
| Publisher Information: |
Jefferson Digital Commons |
| Publication Year: |
2025 |
| Collection: |
Jefferson Digital Commons (Thomas Jefferson University, Philadelphia) |
| Subject Terms: |
adjuvant therapy; disease management; lymph node metastasis; prostate cancer; salvage therapy; Medicine and Health Sciences; Radiation Medicine; Urology |
| Description: |
Background/Objectives: Data from clinical trials showing the non-inferiority of early salvage radiotherapy were recently incorporated into societal guideline statements. However, questions remain regarding ideal prostate-specific antigen (PSA) criteria for salvage, and how to apply these findings to pathologic lymph node-positive (pN+) disease. We investigated variance in management of clinically localized prostate cancer found to have high-risk features after radical prostatectomy. Methods: We retrospectively identified patients from May 2015 to January 2024 utilizing a multi-institutional, regional collaborative database. The primary outcome was identifying factors associated with the receipt of adjuvant versus salvage therapy. Factors associated with secondary treatment were assessed via multivariable logistic regression. Results: In total, 230 (38%) patients received adjuvant and 375 (62%) received salvage therapy. Rates of adjuvant versus salvage therapy differed by practice setting (p < 0.001). A higher percentage of patients received salvage (38.9%) over adjuvant (13.5%) therapy in or after 2020 (p < 0.001). In our model, patients with preoperative PSA ≥ 10 ng/mL (OR: 2.15, CI: 1.31–3.53) and treatment in or after 2020 (OR: 3.41, CI: 1.75–6.66) had higher odds, while patients with persistent detectable postoperative PSA ≥ 0.1 ng/mL had lower odds (OR: 0.39, CI: 0.20–0.74) of undergoing salvage therapy. Among pN+ patients, 51% received adjuvant and 49% received salvage therapy. Conclusions: The management of high-risk prostate cancer remains varied. In our regional cohort, rates of salvage versus adjuvant therapy increased after publication of level-one evidence. Further work is warranted to better delineate who will most benefit from adjuvant versus early salvage therapy. © 2025 by the authors. |
| Document Type: |
article in journal/newspaper |
| File Description: |
application/pdf |
| Language: |
English |
| Relation: |
https://jdc.jefferson.edu/urologyfp/91; https://jdc.jefferson.edu/context/urologyfp/article/1098/viewcontent/Real_World_Management_of_High_Risk_Prostate_Cancer_Post_Radical_Prostatectomy__Insights_from_a_Regional_Quality_Collaborative.pdf |
| Availability: |
https://jdc.jefferson.edu/urologyfp/91; https://jdc.jefferson.edu/context/urologyfp/article/1098/viewcontent/Real_World_Management_of_High_Risk_Prostate_Cancer_Post_Radical_Prostatectomy__Insights_from_a_Regional_Quality_Collaborative.pdf |
| Rights: |
http://creativecommons.org/licenses/by/4.0/ |
| Accession Number: |
edsbas.2C97084A |
| Database: |
BASE |