In a second study, Dr. Showalter and his colleagues mined the Surveillance, Epidemiology, and End Results-Medicare linked database and identified patients with prostate cancer who were diagnosed from 1995 to 2007 and had one or more adverse pathological features postprostatectomy.

The group consisted of 6,137 men who received prostatectomy alone (4,509 patients) or with adjuvant radiation therapy (894 patients) or salvage radiation therapy (734 patients).

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The researchers found that earlier radiation therapy was not associated with higher rates of gastrointestinal, genitourinary, or sexual events.2

Dr. Showalter said the findings shine a new light on an issue that has long divided the medical community with many radiation oncologists preferring adjuvant therapy and many urologists preferring salvage therapy.

Dr. Showalter said urologists tend to prefer to forgo adjuvant radiation therapy because they fear the side effects, and radiation oncologists tend to prefer offering adjuvant radiation therapy because they fear the risk of metastasis.

Daniel A. Barocas, MD, who is an assistant professor of Urologic Surgery at Vanderbilt University Medical Center in Nashville, TN, said physicians recommend delaying radiation therapy after prostatectomy in order to allow urinary and sexual function to recover and stabilize before adding additional toxicity.

RELATED: Cardiovascular Risk in Men with Prostate Cancer on GnRH Agonist Therapy

“The fact that the authors did not find adverse consequences of radiation in all domains, and did not find an effect of the timing of the radiation could be because there are no such effects, or because their outcome measure is not sensitive enough. The dataset used is powerful, in that it contains administrative codes for specific diagnoses and treatments. However, the study lacks any patient-reported information, which may be more sensitive for identifying quality of life differences between different treatment strategies, or timing of treatment,” Dr. Barocas told Cancer Therapy Advisor.

Dr. Barocas said these two studies may not be sufficient to determine whether there are patient-centered differences in sexual function and urinary incontinence.

There may be some differences that are not large enough to require different types of medical and surgical interventions that are identifiable by diagnostic and procedural billing codes.


  1. Showalter TN, Hegarty SE, Rabinowitz C, et al. Assessing adverse events of postprostatectomy radiation therapy for prostate cancer: evaluation of outcomes in the regione emilia-romagna, Italy. Int J Radiat Oncol Biol Phys. 2015;91(4):752-759.
  2. Hegarty SE, Hyslop T, Dicker AP, Showalter TN. Radiation therapy after radical prostatectomy for prostate cancer: evaluation of complications and influence of radiation timing on outcomes in a large, population-based cohort. PLoS One. 2015;10(2):e0118430.