Adjuvant radiotherapy or early salvage radiotherapy in pT3R0 or pT3R1 prostate cancer.

PURPOSE OF REVIEW: As the appropriate management of patients after prostatectomy is still controversial, the two major approaches, adjuvant radiotherapy (ART) vs. prostate-specific antigen-based surveillance and - upon biochemical recurrence - salvage radiotherapy (SRT) are discussed.

RECENT FINDINGS: Three prospectively randomized clinical trials into ART with 5-12 years median follow-up and overall 1800 patients show a significant gain in freedom from biochemical recurrence after prostatectomy and adjuvant irradiation (hazard ratio ∼0.5). Only one study reported an improved overall survival (hazard ratio 0.72). Patients with pT3 and positive surgical margins are the most likely to profit from ART. Retrospective analyses of adjuvant vs. SRT suggest a similar oncological outcome if SRT is given early after recurrence, that is at a prostate-specific antigen of 0.5 ng/ml or less. Also, toxicity is similar with the two strategies. With positive lymph nodes, hormone therapy and optionally extended field radiotherapy can be recommended.

SUMMARY: The alternative ART or surveillance along with SRT after prostatectomy cannot yet be decided on conclusively. Compliance, physical side-effects, psychological aspects and life expectancy should be taken into account when discussing treatment options. Ongoing and planned trials will hopefully identify subgroups that profit most from one or the other strategy.