3223 - Real World Utilization of Salvage Radiotherapy (SRT) in Biochemically Recurrent (BCR) Prostate Cancer Patients
Presenter(s)
M. O. Finkelstein1, A. S. Bart2, J. A. Efstathiou3, P. L. Nguyen4, E. D. Crawford5, D. M. Albala6, I. Aleksic6, E. Cone7, S. Faisal6, M. Grice6, P. Lam6, B. Martin8, C. Pieczonka6, T. R. Price7, S. Randall6, C. Reichard9, A. Robinson6, S. Jason10, D. Vanderbilt6, and S. E. Finkelstein6; 1Barrett, the Honors College Arizona State University, Tempe, AZ, 2Associated Medical Professionals of NY, Syracuse, NY, 3Massachusetts General Hospital, Boston, MA, 4Department of Radiation Oncology, Brigham and Women’s Hospital/Dana-Farber Cancer Institute, Boston, MA, 5Department of Urology, University of California San Diego School of Medicine, San Diego, CA, 6Associated Medical Professionals of NY / US Urology Partners, Syracuse, NY, 7Urology of Indiana / US Urology Partners, Greenwood, IN, 8Central Ohio Urology Group / US Urology Partners, Columbus, OH, 9Urology of Indiana / US Urology Partners, Carmel, IN, 10Central Ohio Urology Group, Columbus, OH
Purpose/Objective(s):
Recent advancements in the management of biochemical recurrence (BCR) following local treatment for prostate cancer have broadened the spectrum of therapeutic options. Herein, we examine the real-world utilization of salvage radiotherapy (SRT) in contemporary BCR prostate cancer patients.Materials/Methods:
This is a retrospective review of prospectively collected data; we reviewed 30,779 active prostate cancer patients within the Precision Point Specialty (PPS) Analytics Portal for Prostate Cancer, a database containing EMR for over 80 active community urology practices. For this initial analysis of over 30000 patients, BCR data was collected over the past 36 months from a large multi-center, multi-specialty group facilitating advanced genitourinary care across the northeast, midwest, and south regions of the United States. SRT eligible after surgical definitive therapy was classically defined as radiation administered > 1 year post-RP and/or after a post-nadir PSA ? 0.1 ng/ml. Failure after primary radiation, HIFU, or cryotherapy therapy was classically defined as PSA 2 ng/ml above nadir. None of the BCR patients included had evidence of metastatic disease. Data on clinicopathologic features, primary therapy, prostate-specific antigen kinetics, and salvage therapy were collected. The analysis examined the relationship of various predictors of utilization adjusting to confounders.Results:
Two thousand and three patients (7%) had BCR; of these BCR patients, 1441 (72%) were post-radical prostatectomy (RP). Only 1002 (66%) of radiation eligible patients received SRT post-RP or cryotherapy or HIFU. In contemporary BCR patients with aggressive disease noted to have Gleason 8 or higher, the radiotherapy utilization rate was only 27.9%. The median time to SRT following RP was 24 months; the median age was 77, with a median PSA of 0.4. The median time to SRT following cryotherapy/HIFU was 48 months; the median age was 78, with a median PSA of 4.5. Further, Gleason grade and pathologic stage were the variables that had the greatest influence on the decision to use SRT. A retrospective review of prospectively collected next generation imaging data and genomic biomarkers is underway.Conclusion:
The data suggests real-world underutilization of salvage radiotherapy in eligible BCR patients with prostate cancer in the community setting. These findings indicate a need for enhanced collaboration between specialties to optimize the care of real-world community prostate cancer patients.