[Adjuvant vs. salvage radiotherapy after radical prostatectomy]

Area of Science:

• Oncology
• Radiation Oncology
• Urologic Oncology

Background:

• Radical prostatectomy (RP) for prostate cancer carries a risk of biochemical recurrence, influenced by pre-operative PSA, Gleason score, and surgical margins.
• High-risk patients face a 50-70% chance of progression, necessitating treatment strategies like adjuvant radiotherapy (ART) or salvage radiotherapy (SRT).

Purpose of the Study:

• To compare the efficacy and outcomes of adjuvant radiotherapy (ART) versus salvage radiotherapy (SRT) following radical prostatectomy (RP) for prostate cancer.
• To evaluate the role of these treatments in managing biochemical recurrence and improving progression-free survival.

Main Methods:

• A literature search was conducted on PubMed, focusing on randomized trials comparing ART and SRT after RP for prostate cancer.
• Analysis of data from 3 randomized phase-III studies evaluating treatment approaches and outcomes.

Main Results:

• Adjuvant radiotherapy (ART) demonstrated a nearly 20% improvement in biochemical progression-free survival compared to a wait-and-see approach, particularly in pT3 prostate cancer with positive margins.
• Salvage radiotherapy (SRT) can re-achieve undetectable PSA in 30-70% of patients with persisting or rising PSA post-RP, offering a curative option.
• ART may be associated with fewer late complications due to lower doses, while SRT avoids overtreatment risks and potential interactions with post-prostatectomy complications.

Conclusions:

• Direct comparison of SRT after PSA progression versus ART for undetectable PSA is inconclusive, with ART indication depending on risk factors.
• ART is supported by high-level evidence for improving freedom from biochemical progression.
• Early initiation of SRT, at the lowest possible PSA level, is recommended for patients with biochemical progression post-RP.