[Role of local radiotherapy after prostatectomy]

Different risk factors of biochemical relapse after prostatectomy have been identified: extra-capsular extension, seminal vesicle invasion and/or involved surgical margin. There is enough evidence in the literature that post-operative adjuvant radiation therapy can improve five and ten years local control rate, disease free survival and metastasis-free survival. Nevertheless, radiotherapy treatment is linked to a low risk of low grade toxicity and only 20-40% of biochemical relapse are observed after prostatectomy even if there is one involved surgical margin. So, it could be reasonable to propose a close monitoring of the PSA ("Prostate Specific Antigen") and adjuvant radiotherapy once the PSA is superior to 0 ng/ml. Rising PSA superior to 0.2 ng/ml after radical prostatectomy, corresponding to biochemical recurrence, is defined as a local relapse when the biochemical relapse is late and the PSA doubling time is superior to 6 months. Then, salvage radiotherapy is effective and has to be proposed taking the age of the patient, his comorbidities and his desires in consideration.