Impact of adherence to multidisciplinary recommendations for adjuvant treatment in radical prostatectomy patients with high risk of recurrence

Abstract Purpose To investigate adherence to recommended adjuvant radiotherapy (aRT) in radical prostatectomy (RP) patients with adverse pathologic features and to analyse outcome of patients who followed or denied this recommendation. Patients and Methods We included 1,140 consecutive RP patients (2006-2015) with non-organ confined (pT3) prostate cancer (PCa) and either positive surgical margins (R1) and/or lymph node involvement (pN1) and non-detectable postoperative PSA who received multidisciplinary aRT recommendations. Patients were stratified into adherence vs. non-adherence to recommendation. Additionally, subgroups within pathological criteria (pT3R1N0, pT3R0N1, pT3R1N1) were analysed. Kaplan-Meier, as well as multivariable Cox regression analyses (MCR) were used to assess biochemical recurrence (BCR)-free survival, metastasis-free survival (MFS), cancer-specific survival (CSS) and overall survival (OS). Results Overall, 508 (44.6%) patients were non-adherent. Of those, 273 (53.6%) did not receive any RT and 235 (46.4%) received salvage RT. At 8 years, BCR-free survival was 57.7 vs. 20.1%, MFS was 76.5 vs. 75.4%, CSS was 91.7 vs. 87.4% and OS was 80.4 vs. 75.8% in adherent vs. non-adherent patients, respectively (p Conclusions Only about 55% of patients followed our multidisciplinary recommendation. Adherent patients were significantly less likely to experience BCR, metastatic progression, CSM and OM. Thus, patients with high risk of recurrence may be advised about the possibility of improved oncological outcomes in case of adherence to aRT recommendations.