Early use of salvage radiotherapy in patients with prostate cancer with biochemical recurrence after radical prostatectomy has consistently been shown to provide better oncological outcomes than late use. However, the corresponding scientific literature might be subject to lead-time bias, given that in virtually all the available comparative studies, investigators calculated the survival period of included patients from the time of salvage radiotherapy — instead of from the time of radical prostatectomy.
This is a preview of subscription content, access via your institution
Access options
Access Nature and 54 other Nature Portfolio journals
Get Nature+, our best-value online-access subscription
$29.99 / 30 days
cancel any time
Subscribe to this journal
Receive 12 print issues and online access
$209.00 per year
only $17.42 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
References
Simmons, M. N., Stephenson, A. J. & Klein, E. A. Natural history of biochemical recurrence after radical prostatectomy: risk assessment for secondary therapy. Eur. Urol. 51, 1175–1184 (2007).
Thompson, I. M. et al. Adjuvant radiotherapy for pathological T3N0M0 prostate cancer significantly reduces risk of metastases and improves survival: long-term followup of a randomized clinical trial. J. Urol. 181, 956–962 (2009).
Bolla, M. et al. Postoperative radiotherapy after radical prostatectomy for high-risk prostate cancer: long-term results of a randomised controlled trial (EORTC trial 22911). Lancet 380, 2018–2027 (2012).
Wiegel, T. et al. Adjuvant radiotherapy versus wait-and-see after radical prostatectomy: 10-year follow-up of the ARO 96-02/AUO AP 09/95 trial. Eur. Urol. 66, 243–250 (2014).
Tendulkar, R. D. et al. Contemporary update of a multi-institutional predictive nomogram for salvage radiotherapy after radical prostatectomy. J. Clin. Oncol. 34, 3648–3654 (2016).
Stish, B. J. et al. Improved metastasis-free and survival outcomes with early salvage radiotherapy in men with detectable prostate-specific antigen after prostatectomy for prostate cancer. J. Clin. Oncol. 34, 3864–3871 (2016).
Sasco, A. Lead time and length bias in case-control studies for the evaluation of screening. J. Clin. Epidemiol. 41, 103–104 (1988).
Briganti, A. et al. Early salvage radiation therapy does not compromise cancer control in patients with pT3N0 prostate cancer after radical prostatectomy: results of a match-controlled multi-institutional analysis. Eur. Urol. 62, 472–487 (2012).
Fossati, N. et al. Long-term impact of adjuvant versus early salvage radiation therapy in pT3N0 prostate cancer patients treated with radical prostatectomy: results from a multi-institutional series. Eur. Urol. http://dx.doi.org/10.1016/j.eururo.2016.07.028 (2016).
Acknowledgements
Quoc-Dien Trinh is supported by an unrestricted educational grant from the Vattikuti Urology Institute, a Clay Hamlin Young Investigator Award from the Prostate Cancer Foundation and a Genentech BioOncology Career Development Award from the Conquer Cancer Foundation of the American Society of Clinical Oncology.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
F.A. has acted as a consultant of GenomeDx Biosciences, this work does not directly relate to the submitted work. The other authors declare no competing interests.
Related links
FURTHER INFORMATION
PowerPoint slides
Rights and permissions
About this article
Cite this article
Seisen, T., Trinh, QD. & Abdollah, F. Could lead-time bias explain the apparent benefits of early salvage radiotherapy?. Nat Rev Urol 14, 193–194 (2017). https://doi.org/10.1038/nrurol.2017.14
Published:
Issue Date:
DOI: https://doi.org/10.1038/nrurol.2017.14