Page 5 - CUA 2020_Onco_Prostate

2020 CUA Abstracts

POD-2.5. Table 3. (cont’d). ROC curve data showing PSA cutoff points (0.01–0.1 ng/mL) at followup times of 9, 12, 18, 24
months postoperatively
PSA at followup time PSA cutoff points Sensitivity (%) Specificity AOC Asymptotic Asymptomatic 95% CI
(ng/mL) (%) significance Lower bound Upper bound
24 months 0.00 96.9 15.2 0.780 p<0.001 0.680 0.881
0.01 90.6 21.9
0.02 84.4 52.4
0.03 75.0 65.7
0.04 71.9 67.6
0.05 65.6 78.1
0.06 62.5 83.8
0.07 59.4 90.5
0.08 40.6 93.3
0.09 37.5 93.3

POD-2.6 performed stratified meta-analysis based on early or late salvage strat-
Adjuvant vs. salvage radiotherapy: Meta-analysis of the effect of egy and assessed, using the chi-squared test, whether this quantitatively
comparator salvage approach on study conclusions affected study conclusions.
Christopher J.D. Wallis , Zachary W. Klaassen , Amy Luckenbaugh , Aaron Results: We identified seven eligible trials. Among four studies (pub-
1
2
1
Laviana , Bimal Bhindi 3 lished as full manuscripts) using a late salvage strategy, use of adjuvant
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1 Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, radiotherapy conferred a significant improvement in biochemical-recur-
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UnitedStates; Division of Urology, Medical College of Georgia at Augusta rence free survival (hazard ratio [HR] 0.47; 95% confidence interval [CI]
2
3
University, Augusta, GA, United States; Division of Urology, University 0.41–0.54) with no significant heterogeneity between studies (I =0%). In
of Calgary, Calgary, AB, Canada contrast, among three studies using an early salvage strategy (presented
Introduction: Early salvage radiotherapy following radical prostatec- only in abstract form to date), biochemical-recurrence-free survival was
tomy is associated with improved biochemical control when compared not improved with the use of adjuvant radiotherapy (HR 1.12; 95% CI
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to late treatment. To date, guidelines advocating adjuvant radiotherapy 0.88–1.42), again with no significant heterogeneity (I =0%). There was
have relied on randomized controlled trials (RCTs) using late salvage a quantitatively significant difference in these estimates of the benefit of
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therapy, while many clinicians have advocated a salvage approach based adjuvant radiotherapy (p<0.00001, I =97.4%), as well as a qualitative
on observational data using early salvage therapy. Recently, RCTs com- difference in the synthesized results of these studies.
paring adjuvant and early salvage radiotherapy have been presented. We Conclusions: The apparent efficacy of adjuvant radiotherapy in prostate
quantitatively explored the effect of changing salvage strategies on the cancer depends on the nature of the salvage therapy administered to
apparent efficacy of adjuvant radiotherapy. patients initially undergoing observation. Consumers of the urological
Methods: We performed a systematic review of RCTs assessing the role literature should consider the validity of study interventions, in addition
of adjuvant radiotherapy in men following radical prostatectomy for pros- to study design and methodology, when appraising a study and applying
tate cancer. On an a priori basis, we classified trials as using an early the results to patient care.
or late salvage strategy as a comparator to adjuvant radiotherapy. We

S32 CUAJ • June 2020 • Volume 14, Issue 6(Suppl2)