Adherence to post-therapeutic multidisciplinary tumor board recommendation and its influence on oncological outcomes in high-risk prostate cancer patients following radical prostatectomy.

BACKGROUND

In prostate cancer (PCa) patients treated with radical prostatectomy (RP), multidisciplinary tumor boards (MDT) issue recommendations to undergo adjuvant (aRT) or salvage radiotherapy (sRT). However, reliable data regarding the adherence rate to MDT recommendations and subsequently its impact on oncological outcomes are scarce.

METHODS

We retrospectively identified patients treated with RP within a certified prostate cancer center between 2012 and 2016, receiving an MDT recommendation to undergo adjuvant or salvage radiotherapy following RP due to adverse pathological features (non-organ confined disease, positive surgical margin, positive lymph node). Patients with a follow-up < 3 years were excluded. Among patients recommended to undergo aRT, adherence rate was calculated. Patients adherent vs. non-adherent to aRT recommendation were compared regarding biochemical recurrence (BCR), PSA failure following aRT or sRT, and cancer-specific (CSS) and overall survival (OS).

RESULTS

Of 802 patients, 408 (51.5%) were recommended to undergo aRT. Among those, 121 (30%) received aRT, whereas 287 (70%) were non-adherent to aRT-MDT recommendation. In multivariable logistic regression models, age, performance status and presence of adverse pathological features represented statistically significant predictors to undergo aRT. Rates of BCR (40.4 vs. 66.6%) as well as subsequent median time of PSA failure following radiotherapy (83 vs. 42 months) favored patients adherent to aRT recommendations (both p < 0.001). No differences were recorded in CSS and OS analyses regarding adherence to aRT recommendations.

CONCLUSION

Solely a fraction of patients followed the recommendation to undergo aRT. Patients adherent to aRT recommendation demonstrated lower rates of subsequent PCa recurrences, albeit not (yet) translating into CSS/OS differences.