It has been widely believed that urinary incontinence and erectile function are worse when postprostatectomy radiation is delivered earlier rather than later.
However, that may not be the case and there does not appear to be any protective effect of delayed radiation compared to earlier radiation, according to two new studies.
In one study, researchers at the University of Virginia School of Medicine analyzed a population-based registry from an Italian regional health system and found that radiation therapy postprostatectomy was associated with increased rates of gastrointestinal and some urinary adverse events (AEs), but not erectile dysfunction (ED) or urinary incontinence.1 The researchers reported that earlier radiation therapy did not appear to increase the rates of AEs.
“This demonstrates that there are no urinary or sexual benefits with delaying therapy. So, you can go ahead and treat early,” said study investigator Timothy Showalter, MD, who is with the University of Virginia School of Medicine Cancer Center in Charlottesville, VA.
Dr. Showalter, who is a radiation oncologist, said the data contradict the clinical principle of delaying radiation as long as possible for the sake of AEs.
He and his colleagues queried the Regione Emilia-Romagna Italian Longitudinal Health Care Utilization Database to identify a cohort of men who underwent RP (radical prostatectomy) between 2003 and 2009.
A total of 9,876 men were included in the analyses and the researchers found exposure to radiation therapy postprostatectomy was associated with increased rates of gastrointestinal (rate ratio [RR] 1.81) and urinary non-incontinence events (RR 1.83), but not urinary incontinence events or ED.
The addition of the time from prostatectomy to radiation therapy was not significant for any of the AE outcomes.
“I was taught it was best to wait as long as possible to allow for recovery of urinary function,” said Dr. Showalter in an interview with Cancer Therapy Advisor. He now thinks that dogma should change.