Post-radical prostatectomy management options for the positive surgical margin: argument for adjuvant radiotherapy

The debate on the optimal management for patients with positive surgical margins following radical prostatectomy is on-going. From published evidence, we established that adjuvant XRT has acceptable, well-tolerated transient toxicity that dissipates with time. We examined the best conditions for optimal results from adjuvant radiotherapy (XRT), when the prostate-specific antigen (PSA) level is very low or undetectable, i.e., in the true adjuvant setting. We also examined the substantial amount of evidence from nonrandomized series, almost unanimously being in favor of early XRT. Most importantly, there is robust Level I evidence from well-executed randomized clinical trials reporting superior biochemical relapse-free and progression-free survival with early adjuvant XRT for patients with positive margins.