Risk stratification system and pattern of relapse in patients treated with adjuvant radiotherapy after radical prostatectomy



To retrospectively evaluate the role of adjuvant radiotherapy (ART) as monotherapy in a cohort of prostate cancer patients with undetectable prostate-specific antigen (PSA) after surgery and to propose a risk stratification system.


Between 2003 and 2010, 174 consecutive patients were treated with ART (median dose 71 Gy) at a single institution. Subsequently, we assigned a score of 1 to the following risk factors (RF): T stage ≥3b, presurgical PSA ≥10 ng/mL, pathologic Gleason score (GS) ≥4 + 3, and positive surgical margin (R1). The scores were then summed to stratify the population into low risk (LR), intermediate risk (IR), and high risk (HR).


Median follow-up was 61 months (range 4-105). Five-year biochemical relapse-free survival (bRFS), clinical relapse-free survival (cRFS), and overall survival (OS) were respectively 93%, 97.1%, and 98.6%. On univariate analyses, GS was the only variable related to bRFS (p = 0.04) and to cRFS (p = 0.05). Any variable was related to OS. Kaplan-Meier analysis showed that HR patients (3-4 RF) had a worse bRFS (p = 0.02) compared to LR patients (0 RF or R1 as single RF); IR patients (1-2 RF) had a lower bRFS compared to LR patients (p = 0.06). Patients with R1 as single RF have the same bRFS as patients with 0 RF (p = 0.6) and are considered as LR patients.


Adjuvant radiotherapy leads to excellent bRFS and cRFS rates at 5 years (93.3% and 97.1%, respectively) in our population. Patients with multiple RF are at higher risk of bRFS. Patients with R1 as single RF have bRFS rates comparable to patients without any RF.

Tumori 2016; 102(3): 323 - 329




Mario Levis, Alessia Guarneri, Niccolò Giaj Levra, Daniel E. Spratt, Sara Bartoncini, Fernando Munoz, Elisabetta Trino, Angela Botticella, Francesca Arcadipane, Umberto Ricardi

Article History


Financial support: Daniel E. Spratt was supported by the Rebecca and Nathan Milikowsky Prostate Cancer Foundation Young Investigator Award.
Conflict of interest: None of the authors has conflict of interest with this submission.

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  •  Department of Oncology, Radiation Oncology, University of Turin, Turin - Italy
  •  Radiation Oncology, AOU City of the Health and of the Science, Turin, Turin - Italy
  •  Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY - USA
  •  Present address: Radiation Oncology, Sacro Cuore-Don Calabria Hospital, Negrar-Verona - Italy
  •  Present address: Radiation Oncology, University Hospitals Leuven/KU Leuven, Leuven - Belgium
  •  Present address: Department of Radiation Oncology, University of Michigan, Ann Arbor, MI - USA
  •  Present address: Radiation Oncology, Tomotherapy Unit, Regional Hospital U. Parini, Aosta - Italy

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