[Adjuvant and salvage radiotherapy after radical prostatectomy]

Currently radical prostatectomy remains the standard mode of treatment for patients with locally and localized stage of prostate cancer. On the other hand, after radical prostatectomy approximately 50% of patients have postoperative positive margin. Therefore implementation of effective mode of adjuvant radiotherapy treatment after radical prostatectomy plays important role in clinic. Currently available data, which evaluated the effectiveness of radiotherapy after radical prostatectomy are based on retrospective studies. These studies indicated that post-operative radiotherapy reduced the local recurrence rate but the influence on the patient's survival is unknown. Generally, the following factors are considered as prognostic for failure: the presence of pathologic T3 (pT3), positive surgical margin, preoperative concentration of prostatic specific antigen (PSA) above 25ng/ml, metastases to lymph nodes, Gleason >7. Radiotherapy is performed as typical adjuvant radiotherapy in case of pT3 or positive margin without rising of PSA level. This mode of treatment is efficient and gives the excellent local control rate but without marked influence on overall survival of patients. Another strategy, which is considered after radical prostatectomy, is salvage radiotherapy. This mode of treatment is introduced when the rising level of PSA and/or the pathological recurrence mass in the tumor bed is occurred. The efficacy of the salvage radiotherapy is lower than classical adjuvant radiotherapy. Still remain questions about the following issues: timing of radiotherapy, optimal dose, treatment technique, involved target for radiotherapy, and the role of adjuvant hormonal therapy. The last issue now is evaluating in the randomized clinical trial. In summary, currently until outcomes from well conducted randomized trials will available patients after radical prostatectomy with adverse significant factors for local recurrence or/and increased level of PSA should be considered for postoperative radiotherapy.