# ARTISTIC meta-analysis

Source: https://onco.cc/trials/artistic-meta-analysis/  
OnCo record `artistic-meta-analysis` (Trial). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Three trials asked the same question and none was big enough alone. Pooling them, planned in advance so nobody could cherry-pick, showed that waiting for the PSA to rise is as good as treating everyone.

## Summary

The ARTISTIC collaboration is a model of how to settle a question that no single trial can answer. The investigators of RADICALS-RT, RAVES and GETUG-AFU 17 agreed a harmonised definition of event-free survival and registered a protocol on PROSPERO before any of the trial results were known, so the pooling could not be shaped by what came out.

Event-free survival was defined as the time from randomisation to the first of biochemical progression (PSA of 0.4 ng/mL or more and rising after any postoperative radiotherapy), clinical or radiological progression, start of a non-trial treatment, death from prostate cancer, or a PSA of at least 2.0 ng/mL at any time. Updated results were obtained for 2,153 men recruited between November 2007 and December 2016, 1,075 assigned adjuvant radiotherapy and 1,078 a policy of early salvage radiotherapy, of whom 421 (39.1 percent) had started treatment at the time of analysis. Median follow-up ranged from 60 to 78 months. Median age was 64 or 65 across trials and 1,671 men (77.6 percent) had a Gleason score of 7. All three trials were assessed as at low risk of bias.

On 270 events there was no evidence that adjuvant radiotherapy improved event-free survival: hazard ratio 0.95 (95 percent confidence interval 0.75 to 1.21, p=0.70), a change in 5-year event-free survival of 1 percentage point (-2 to 3), 89 against 88 percent. Results were consistent across trials (heterogeneity p=0.18, I-squared 42 percent).

The conclusion, that early salvage treatment is preferable because it spares many men radiotherapy and its side effects, is the practice today. The honest caveat the authors made is that long-term outcomes, including metastasis and death, are still awaited.

## Fields

- Kind: Trial
- Status: negative
- Last checked: 2026-09-25
- Also known as: ARTISTIC; Adjuvant Radiotherapy Timing In Selected Treatment Individuals after Prostatectomy Consortium
- Phase: observational
- Setting: Prospectively planned systematic review and meta-analysis of the three randomised trials comparing immediate adjuvant radiotherapy with early salvage radiotherapy after radical prostatectomy, using a harmonised definition of event-free survival agreed before any trial reported
- Sponsor: MRC Clinical Trials Unit at UCL, funded by the UK Medical Research Council
- Enrolled: 2153
- Result: Event-free survival hazard ratio 0.95 (95 percent confidence interval 0.75 to 1.21, p=0.70) for adjuvant against early salvage radiotherapy, a 1 percentage point difference at 5 years (89 against 88 percent), across 2,153 men in three trials.
- Outcomes: Event-free survival: Adjuvant radiotherapy 89% vs Policy of early salvage radiotherapy 88%, HR 0.95

## Sources

- ARTISTIC prospectively planned meta-analysis (Lancet 2020): https://doi.org/10.1016/S0140-6736(20)31952-8
- PROSPERO CRD42019132669: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=132669

## Connected records

- cancers: [Biochemical recurrence of prostate cancer](https://onco.cc/cancers/prostate-bcr/), [Localised prostate cancer, high and very high risk](https://onco.cc/cancers/prostate-high-risk/), [Prostate cancer](https://onco.cc/cancers/prostate/)
- technologies: [IMRT / IGRT (modern external beam)](https://onco.cc/technologies/imrt-igrt/)
- companies: [MRC Clinical Trials Unit at UCL](https://onco.cc/companies/mrc-ctu/)
- terms: [Biochemical recurrence (BCR)](https://onco.cc/terms/biochemical-recurrence/), [Neoadjuvant / adjuvant / perioperative](https://onco.cc/terms/neoadjuvant-adjuvant/), [Radical prostatectomy](https://onco.cc/terms/prostatectomy/), [Salvage therapy](https://onco.cc/terms/salvage-therapy/)
- trials: [EORTC 22911](https://onco.cc/trials/eortc-22911/), [GETUG-AFU 17](https://onco.cc/trials/getug-afu-17/), [RADICALS-RT](https://onco.cc/trials/radicals-rt/), [RAVES (TROG 08.03/ANZUP)](https://onco.cc/trials/raves/), [SWOG 8794](https://onco.cc/trials/swog-8794/)

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