Salvage radiotherapy after radical prostatectomy: functional outcomes in the LAPPRO trial after 8-year follow-up

Authors

  • Stefan Carlsson Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden https://orcid.org/0000-0002-8489-5029
  • David Bock Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Scandinavian Surgical Outcomes Research Group, Gothenburg, Sweden https://orcid.org/0000-0001-9111-9602
  • Anna Lantz Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden; Division of Biostatistics, IMM, Karolinska Institutet, Stockholm, Sweden https://orcid.org/0000-0002-5335-8028
  • Eva Angenete Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Scandinavian Surgical Outcomes Research Group, Gothenburg, Sweden; Department of Surgery, Region Västra Götaland, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden https://orcid.org/0000-0001-9966-4904
  • Katarina Koss Modig Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Urology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden https://orcid.org/0000-0002-6396-0645
  • Jonas Hugosson Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Urology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden https://orcid.org/0000-0002-2324-2817
  • Anders Bjartell Department of Urology, Skåne University Hospital, Malmö, Sweden; Department of Translational Medicine, Division of Urological Cancers, Lund University, Lund, Sweden https://orcid.org/0000-0002-5761-3786
  • Gunnar Steineck Department of Oncology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden https://orcid.org/0000-0002-0787-3969
  • Peter Wiklund Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden; Department of Urology, Icahn School of Medicine at Mount Sinai Health System, New York, NY, USA https://orcid.org/0000-0001-6497-4697
  • Eva Haglind Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Scandinavian Surgical Outcomes Research Group, Gothenburg, Sweden; Department of Surgery, Region Västra Götaland, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden https://orcid.org/0000-0002-1147-5605

DOI:

https://doi.org/10.2340/sju.v58.7318

Keywords:

prostate cancer, radical prostatectomy, radiotherapy, trial emulation, bowel function

Abstract

Objective: Radical prostatectomy reduces mortality among patients with localized prostate cancer, however up to 35% of patients will experience biochemical recurrence, often treated with salvage radiotherapy. The objective of the study was to investigate long-term effects of salvage radiotherapy.
Methods: A prospective, controlled, non-randomized trial at 14 Swedish center’s including 4,003 patients scheduled for radical prostatectomy 2008–2011. A target trial emulation approach was used to identify eligible patients that was treated with salvage radiotherapy. The control group received no salvage radiotherapy. Outcomes were assessed by patient questionnaires on ordinal scales and statistical group comparisons were made using ordered logit regression with adjustment for baseline outcome and confounding factors. The primary endpoints were bowel, urinary and sexual function and bothering due to dysfunction at 8 years.
Results: Eleven percent (330/3,139) of the analyzed study population received salvage radiotherapy. Fecal leakage, leakage of mucus and hematochezia were more common after receiving salvage radiotherapy compared with the control group; 4.5% versus 2.6% odds ratio (95% confidence interval [CI]): (1.90 [1.38; 2.62]), 6.8% versus 1.5% 4.14 (2.98; 5.76) and 8.6% versus 1.2% 4.14 (2.98; 5.76), respectively. Urinary incontinence, erectile dysfunction and hematuria were more common after receiving salvage radiotherapy, 34% versus 23% 2.23 (2.65; 3.00), 65% versus 57% 1.65 (1.18; 2.29) and 16% versus 1.6% 11.17 (5.68; 21.99), respectively.
Conclusion: Salvage radiotherapy was associated with increased risk for fecal leakage, hematochezia, urinary incontinence and hematuria. Our results emphasize the importance of selecting patients for salvage radiotherapy to avoid overtreatment and to give high quality pre-treatment information to ensure patients’ preparedness for late side-effects.

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Published

2023-05-11

How to Cite

Carlsson, S., Bock, D., Lantz, A., Angenete, E., Koss Modig, K., Hugosson, J., Bjartell, A., Steineck, G., Wiklund, P., & Haglind, E. . (2023). Salvage radiotherapy after radical prostatectomy: functional outcomes in the LAPPRO trial after 8-year follow-up. Scandinavian Journal of Urology, 58, 11–19. https://doi.org/10.2340/sju.v58.7318

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Vol. 58 (2023)

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Copyright (c) 2023 Stefan Carlsson, David Bock, Anna Lantz, Eva Angenete, Katarina Koss Modig, Jonas Hugosson, Anders Bjartell, Gunnar Steineck, Peter Wiklund, Eva Haglind

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Acta Chirurgica Scandinavica Society owns the copyright for all material published until Volume 57 (2023) unless otherwise specified. As from Volume 59 (2024) all published articles, unless otherwise specified, are published under CC-BY licences, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for non-commercial purposes, provided proper attribution to the original work.

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