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The following is a summary of “Prognostic factors in post-prostatectomy salvage radiotherapy setting with and without hormonotherapy: An individual patient data analysis of randomized trials from ICECaP database,” published in the September 2024 issue of Oncology by Pommier et al.

Early salvage radiotherapy (SRT) is the recommended standard of care for patients experiencing biochemical recurrence after prostatectomy, although clinical outcomes remain variable. This study aimed to develop a risk-scoring system to enhance prognostication and guide treatment decisions for patients receiving SRT, with or without hormonal therapy (HT), based on key clinicopathological factors. The analysis utilized data from the Intermediate Clinical Endpoints in Cancer of the Prostate (ICECaP) database, incorporating individual patient data from 1,647 participants enrolled in three randomized trials (GETUG-AFU-16, NRG/RTOG-9601, and a subset of EORTC-22911). The primary outcomes measured were clinical progression (CP), metastasis-free survival (MFS), and overall survival (OS). Clinico-pathological variables, including pathological Gleason Score (GS), PSA levels at the start of SRT, surgical margin status, presence of persistent PSA post-radical prostatectomy (RP), and the interval from RP to SRT, were evaluated using multivariable models stratified by treatment type.

Multivariable analysis identified three critical prognostic factors: PSA ≥ 0.5 ng/mL at SRT initiation, GS ≥ 8, and negative surgical margin status. Based on the number of these risk factors, patients were stratified into three prognostic groups: high risk (2-3 factors), intermediate risk (1 factor), and low risk (0 factors). This stratification demonstrated strong associations with OS, MFS, and CP outcomes, regardless of whether patients received SRT alone or with HT. The risk group classification was further validated in patients with persistent PSA following RP and those treated within one year of RP, with similar prognostic relevance in both the SRT-only and SRT-plus HT cohorts.

In conclusion, the proposed risk scoring system, incorporating three standard-of-care clinicopathological factors, offers robust prognostic information for patients undergoing SRT with or without HT. This tool can provide individualized patient counseling, refine risk stratification, and optimize treatment planning in managing biochemical recurrence post-prostatectomy.

Source: sciencedirect.com/science/article/pii/S0167814024035102