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Updated: May 17, 2026
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Retzius-Sparing Robot-Assisted Radical Prostatectomy
Published on: May 19, 2022
Radiotherapy after radical prostatectomy: immediate or early delayed?
D Bottke1, D Bartkowiak, M Schrader
1University Hospital Ulm, Ulm, Germany. dirk.bottke@uniklinik-ulm.de
Summary
Adjuvant radiotherapy (ART) shows benefit for biochemical progression-free survival after prostatectomy, especially with positive margins. Early salvage radiotherapy (SRT) offers a second chance for cure with low side effects.
Area of Science:
- Oncology
- Radiation Oncology
- Urology
Background:
- Biochemical recurrence after radical prostatectomy (RP) affects 50-70% of high-risk patients.
- Risk indicators include Gleason score, PSA, tumor stage, and positive margins.
- Treatment options include adjuvant radiotherapy (ART) or salvage radiotherapy (SRT).
Purpose of the Study:
- To compare adjuvant radiotherapy (ART) and salvage radiotherapy (SRT) for biochemical recurrence after radical prostatectomy (RP).
- To evaluate the efficacy and outcomes of ART versus SRT based on available data.
Main Methods:
- Review of published data from randomized phase III trials on ART and SRT.
- Comparison of treatment approaches based on biochemical progression-free survival and side effect rates.
Main Results:
- ART demonstrated a ~20% absolute benefit in biochemical progression-free survival versus a 'wait and see' approach.
- Greatest ART benefit observed in patients with positive margins and pT3 tumors.
- SRT can decrease PSA in 30-70% of patients, offering a second curative opportunity with comparably low side effects.
Conclusions:
- The equivalence of early SRT versus ART remains uncertain.
- Early initiation of SRT is recommended when indicated for PSA recurrence after RP.
