Prostate
Patient-reported follow-on from RAVES quantifying the continence cost of adjuvant vs salvage RT after RP.
TROG 08.03 RAVES QOL Substudy
ForPost-RP prostate cancer with adverse pathology or PSA >0.2 ng/ml
TL;DRAt 5yr, 16% vs 2% severe urinary leakage aRT vs no RT (p=0.01); sRT timing had no QOL effect.
The mechanism of sRT's benefit is sparing, not delay: time from RP to RT showed no association with any QOL domain at 3-5 yr (all coefficients ns), and irradiated sRT pts looked like aRT pts. The gain sits entirely with the men who never need RT, so late salvage confers no functional dividend over early salvage.
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Planned secondary analysis of the TROG 08.03 RAVES randomised trial comparing adjuvant RT with salvage RT delivered at PSA >0.2 ng/ml after radical prostatectomy. Patient-reported QOL collected prospectively across multiple Australian and New Zealand sites.
EORTC QLQ-C30 and QLQ-PR25. The unit of analysis is a minimal clinically important change (MCIC), a decline of >0.5 SD from baseline, in bowel symptoms, urinary symptoms, sexual activity, and sexual functioning.
The aRT arm (n=166) reported more bowel-symptom MCIC at 1-5 yr than sRT pts who never required RT. Against pts in the sRT group who did receive RT, no consistent differences in urinary, bowel, or sexual domains emerged.
| Timepoint | Adjuvant RT | No RT | p |
|---|---|---|---|
| 4 yr | 15/124 (12%) | 1/59 (1.7%) | 0.02 |
| 5 yr | 18/111 (16%) | 1/50 (2%) | 0.01 |
| Domain / timepoint | aRT | sRT | p |
|---|---|---|---|
| Sexual activity MCIC, 3 yr | 32% | 58% | 0.004 |
| Sexual activity MCIC, 4 yr | 43% | 65% | 0.038 |
| Urinary symptom MCIC, 2 yr | 23% | 38% | 0.036 |
| Severe urinary leakage, 5 yr | 16% | 13% | 0.7 |
Dose, fractionation, and target volume are not reported in the source text. Median follow-up from RT was 2.6 yr in the salvage group who received RT (IQR 1.2-5.2), and aRT pts started RT younger (63.9 vs 66.8 yr, p=0.01).
Self-reported QOL in an unblinded trial, so expectancy cuts toward the arm that knows it was irradiated. Denominators thin sharply by 5 yr (23 sRT pts post-RT; 8 in the no-RT sexual-functioning group), and the scattered significant timepoints in the aRT-vs-sRT comparison are fragile at that N.
Reframes the early-salvage rationale: the QOL dividend is sparing roughly the share of men who never trigger RT, not delaying exposure. That matters because delay was the intuitive mechanism, and the regression data do not support it.
Prespecified secondary QOL analysis of a randomised trial; supports the already-guideline-endorsed early-salvage strategy. Small late-timepoint denominators and unblinded self-report temper it.
In post-RP men with adverse pathology deciding adjuvant versus PSA-triggered salvage, this supports counselling that the QOL advantage comes from avoiding RT altogether rather than from postponing it; it does not inform men who already have a rising PSA and will be irradiated either way.
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