Adjuvant Radiotherapy Use and Patterns of Care Analysis for Margin-positive Prostate Adenocarcinoma with Extracapsular Extension: Postprostatectomy Adjuvant Radiotherapy: A SEER Analysis

OBJECTIVES To perform a patterns of care analysis for patients with prostate cancer and high-risk pathologic factors following radical prostatectomy with regards to adjuvant radiation. METHODS A retrospective analysis was conducted using the Surveillance, Epidemiology and End Results (SEER) Program. We identified men from 2004 to 2005 with prostate adenocarcinoma (PA) who had undergone radical prostatectomy (RP) and were found to have extracapsular extension (ECE) with positive margins. RESULTS We identified 1427 PA patients with ECE and positive margins after an RP. Most were clinically staged as T1 or T2 before surgery (95.8%). Using the D'Amico Risk Stratification, 52.0% were high-risk, 39.7% were intermediate-risk, and 8.3% were low-risk. Of these, 18.2% (260) received ART, whereas 81.8% (1167) did not. Those who received ART had worse prognostic factors, such as Gleason scores > 7 (38.5% vs 24.8%; P < .0001), prostate-specific antigen level > 10 (44.6% vs 35.2%; P = .0045), pathologically positive lymph nodes (11.5% vs 6.4%; P = .006), and D'Amico high-risk disease (66.8% vs 48.7%; P = .0001). The use of ART based on geographic region ranged from 8.3%-34.2%. CONCLUSIONS Less than 20% of patients with pT3 disease and positive margins received ART in the study period just before the publication of randomized data demonstrating an improvement in biochemical failure with ART in this SEER retrospective analysis. This is the largest patterns of care analysis to date of ART in patients with margin-positive pT3 prostate adenocarcinoma. UROLOGY 76: 1169-1174, 2010. Published by Elsevier Inc.