Introduction: The aim of this study was to investigate non-adherence rates to adjuvant radiotherapy (aRT) after radical prostatectomy (RP) and to obtain patient reported reasons for rejecting aRT despite recommendation by a multidisciplinary team discussion (MTD). Methods: In a retrospective monocentric analysis, we identified 1,197 prostate cancer patients who underwent RP between 2014 and 2022 at our institution, of which 735 received a postoperative MTD recommendation. Patients with a recommendation for aRT underwent a structured phone interview with predefined standardised qualitative and quantitative questions and were stratified into “adherent” (aRT performed) and “non-adherent” groups (aRT not performed). Results: Of 55 patients receiving a recommendation for aRT (7.5% of all RP patients), 24 (44%) were non-adherent. Baseline tumour characteristics were comparable among the groups. “Fear of radiation damage” was the most common reason for rejection, followed by “lack of information,” “feeling that the treating physician does not support the recommendation” and “the impression that aRT is not associated with improved oncological outcome.” Salvage radiotherapy was performed in 25% of non-adherent patients. Conclusion: High rates of non-adherence to aRT after RP were observed, and reasons for this phenomenon are most likely multifactorial. Multidisciplinary and individualized patient counselling might be a key for increasing adherence rates.

In men with aggressive prostate cancer, the addition of radiotherapy after the removal of the prostate through surgery (radical prostatectomy) is sometimes recommended. Our investigation focused on understanding why certain men opted against this additional radiotherapy. Our study included 1,197 men who underwent surgery between 2014 and 2022. Through interviews with men recommended for radiotherapy, we aimed to comprehend the reasons behind their choices – categorized as adherent (choosing radiotherapy) or non-adherent (not choosing radiotherapy). Out of the 55 men advised for radiotherapy, 31 (56%) opted for it, while 24 (44%) did not. The primary rationale for not choosing radiotherapy was fear of radiation damage. Other contributing factors included insufficient information, perceived lack of doctor support, and scepticism about the therapy’s efficacy in improving cancer outcomes. In conclusion, a noteworthy number of men did not adhere to the recommended additional radiotherapy post-prostate surgery. Acknowledging the diverse factors influencing men’s decisions, it is crucial for doctors to provide personalized counselling that addresses individual concerns.

1.
Tilki
D
,
Chen
M-H
,
Wu
J
,
Huland
H
,
Graefen
M
,
D’Amico
AV
.
Adjuvant versus early salvage radiation therapy after radical prostatectomy for pN1 prostate cancer and the risk of death
.
J Clin Oncol
.
2022
;
40
(
20
):
2186
92
. .
2.
Thompson
IM
,
Tangen
CM
,
Paradelo
J
,
Lucia
MS
,
Miller
G
,
Troyer
D
, et al
.
Adjuvant radiotherapy for pathologically advanced prostate cancer: a randomized clinical trial
.
JAMA
.
2006
;
296
(
19
):
2329
35
. .
3.
Bolla
M
,
Van Poppel
H
,
Collette
L
,
Van Cangh
P
,
Vekemans
K
,
Da Pozzo
L
, et al
.
Postoperative radiotherapy after radical prostatectomy: a randomised controlled trial (EORTC trial 22911)
.
Lancet
.
2005
;
366
(
9485
):
572
8
. .
4.
Kneebone
A
,
Fraser-Browne
C
,
Duchesne
GM
,
Fisher
R
,
Frydenberg
M
,
Herschtal
A
, et al
.
Adjuvant radiotherapy versus early salvage radiotherapy following radical prostatectomy (TROG 08.03/ANZUP RAVES): a randomised, controlled, phase 3, non-inferiority trial
.
Lancet Oncol
.
2020
;
21
(
10
):
1331
40
. .
5.
Mottet
N
,
Cornford
P
,
Van den Bergh
R
, et al
.
EAU - EANM - ESTRO - ESUR - ISUP - SIOG guidelines on prostate cancer 2023
. European Association of Urology Guidelines. 2023 Edition.
Arnhem, The Netherlands
:
European Association of Urology Guidelines Office
;
2023
.
6.
Specchia
ML
,
Frisicale
EM
,
Carini
E
,
Di Pilla
A
,
Cappa
D
,
Barbara
A
, et al
.
The impact of tumor board on cancer care: evidence from an umbrella review
.
BMC Health Serv Res
.
2020
;
20
(
1
):
73
. .
7.
El Saghir
NS
,
Keating
NL
,
Carlson
RW
,
Khoury
KE
,
Fallowfield
L
.
Tumor boards: optimizing the structure and improving efficiency of multidisciplinary management of patients with cancer worldwide
.
Am Soc Clin Oncol Educ Book
.
2014
;(
34)
:
e461
6
. .
8.
Prades
J
,
Remue
E
,
van Hoof
E
,
Borras
JM
.
Is it worth reorganising cancer services on the basis of multidisciplinary teams (MDTs)? A systematic review of the objectives and organisation of MDTs and their impact on patient outcomes
.
Health Policy
.
2015
;
119
(
4
):
464
74
. .
9.
Knipper
S
,
Sadat-Khonsari
M
,
Boehm
K
,
Mandel
P
,
Budäus
L
,
Steuber
T
, et al
.
Impact of adherence to multidisciplinary recommendations for adjuvant treatment in radical prostatectomy patients with high risk of recurrence
.
Clin Genitourin Cancer
.
2020
;
18
(
2
):
e112
21
. .
10.
Daly
T
,
Hickey
BE
,
Lehman
M
,
Francis
DP
,
See
AM
.
Adjuvant radiotherapy following radical prostatectomy for prostate cancer
.
Cochrane Database Syst Rev
.
2011
(
12
):
CD007234
. .
11.
Mattei
P
,
Würnschimmel
C
,
Di Pierro
GB
.
Standardized and simplified extended pelvic lymph node dissection during robot-assisted radical prostatectomy: the „monoblock” technique
.
2017
. https://surgeryinmotion-school.org/steps/prostate/74/oncology/33/prostate-cancer/9/eplnd-monoblock/42/procedure-types/0/robotic-assisted/102/.
12.
Mattei
A
,
Würnschimmel
C
,
Baumeister
P
,
Hyseni
A
,
Afferi
L
,
Moschini
M
, et al
.
Standardized and simplified robot-assisted superextended pelvic lymph node dissection for prostate cancer: the monoblock technique
.
Eur Urol
.
2020
;
78
(
3
):
424
31
. .
13.
Mattei
A
,
Naspro
R
,
Annino
F
,
Burke
D
,
Guida
R
Jr
,
Gaston
R
.
Tension and energy-free robotic-assisted laparoscopic radical prostatectomy with interfascial dissection of the neurovascular bundles
.
Eur Urol
.
2007
;
52
(
3
):
687
94
. .
14.
Corporation IBM
.
IBM SPSS statistics for windows
.
2021
.
15.
Parker
CC
,
Clarke
NW
,
Cook
AD
,
Kynaston
HG
,
Petersen
PM
,
Catton
C
, et al
.
Timing of radiotherapy after radical prostatectomy (RADICALS-RT): a randomised, controlled phase 3 trial
.
Lancet
.
2020
;
396
(
10260
):
1413
21
. .
16.
Sargos
P
,
Chabaud
S
,
Latorzeff
I
,
Magné
N
,
Benyoucef
A
,
Supiot
S
, et al
.
Adjuvant radiotherapy versus early salvage radiotherapy plus short-term androgen deprivation therapy in men with localised prostate cancer after radical prostatectomy (GETUG-AFU 17): a randomised, phase 3 trial
.
Lancet Oncol
.
2020
;
21
(
10
):
1341
52
. .
17.
Tilki
D
,
D’Amico
AV
.
Timing of radiotherapy after radical prostatectomy
.
Lancet
.
2020
;
396
(
10260
):
1374
5
. .
18.
Ghadjar
P
,
Höcht
S
,
Wiegel
T
.
Postoperative radiotherapy in prostate cancer
.
Lancet
.
2021
;
397
(
10285
):
1623
. .
19.
Nguyen
DD
,
Satkunasivam
R
,
Wallis
CJD
.
Tackling depression and suicide among prostate cancer survivors: from clinical innovations to continued advocacy on the upstream social determinants of health
.
Eur Urol
.
2023
;
84
(
3
):
273
4
. .
20.
Todio
E
,
Sharp
J
,
Morrow
A
,
Taylor
N
,
Schofield
P
,
Mazariego
C
.
Examining the effectiveness and implementation of patient treatment decision-aid tools for men with localised prostate cancer: a systematic review
.
Psychooncology
.
2023
;
32
(
4
):
469
91
. .
21.
Huelster
HL
,
Laviana
AA
,
Joyce
DD
,
Huang
L-C
,
Zhao
Z
,
Koyama
T
, et al
.
Radiotherapy after radical prostatectomy: effect of timing of postprostatectomy radiation on functional outcomes
.
Urol Oncol
.
2020
;
38
(
12
):
930.e23
32
. .
22.
Wallis
CJD
,
Cheung
P
,
Herschorn
S
,
Saskin
R
,
Su
J
,
Klotz
LH
, et al
.
Complications following surgery with or without radiotherapy or radiotherapy alone for prostate cancer
.
Br J Cancer
.
2015
;
112
(
6
):
977
82
. .
23.
Matzinger
O
,
Duclos
F
,
van den Bergh
A
,
Carrie
C
,
Villà
S
,
Kitsios
P
, et al
.
Acute toxicity of curative radiotherapy for intermediate- and high-risk localised prostate cancer in the EORTC trial 22991
.
Eur J Cancer
.
2009
;
45
(
16
):
2825
34
. .
24.
Geraerts
I
,
Van Poppel
H
,
Devoogdt
N
,
Van Cleynenbreugel
B
,
Joniau
S
,
Van Kampen
M
.
Prospective evaluation of urinary incontinence, voiding symptoms and quality of life after open and robot‐assisted radical prostatectomy
.
BJU Int
.
2013
;
112
(
7
):
936
43
. .
25.
Lane
JA
,
Donovan
JL
,
Young
GJ
,
Davis
M
,
Walsh
EI
,
Avery
KNL
, et al
.
Functional and quality of life outcomes of localised prostate cancer treatments (Prostate Testing for Cancer and Treatment [ProtecT] study)
.
BJU Int
.
2022
;
130
(
3
):
370
80
. .
26.
Jenkins
DK
,
Swanson
GP
,
Jhavar
SG
,
Wagner
KR
,
Ha
CS
,
Chen
W
.
The effect of radiation therapy on post-prostatectomy urinary function
.
Rep Pract Oncol Radiother
.
2020
;
25
(
3
):
442
6
. .
27.
Marquez
R
,
Manning
MA
,
Mohamed
MK
.
Resolving transportation disparity in cancer care
.
J Clin Oncol
.
2021
;
39
(
28_Suppl l
):
96
–. .
28.
Würnschimmel
C
,
Tilki
D
,
Huland
H
,
Graefen
M
,
Beyer
B
.
Qualitätskriterien in der Urologie
.
Urologe
.
2021
;
60
(
2
):
193
8
. .
29.
Kowalczyk
KJ
,
Gu
X
,
Nguyen
PL
,
Lipsitz
SR
,
Trinh
QD
,
Lynch
JH
, et al
.
Optimal timing of early versus delayed adjuvant radiotherapy following radical prostatectomy for locally advanced prostate cancer
.
Urol Oncol
.
2014
;
32
(
3
):
303
8
. .
30.
Feng
M
,
Hanlon
AL
,
Pisansky
TM
,
Kuban
D
,
Catton
CN
,
Michalski
JM
, et al
.
Predictive factors for late genitourinary and gastrointestinal toxicity in patients with prostate cancer treated with adjuvant or salvage radiotherapy
.
Int J Radiat Oncol Biol Phys
.
2007
;
68
(
5
):
1417
23
. .
31.
Zaffuto
E
,
Gandaglia
G
,
Fossati
N
,
Dell’Oglio
P
,
Moschini
M
,
Cucchiara
V
, et al
.
Early postoperative radiotherapy is associated with worse functional outcomes in patients with prostate cancer
.
J Urol
.
2017
;
197
(
3 Pt 1
):
669
75
. .
You do not currently have access to this content.