Radiation Therapy After Radical Prostatectomy: What Has Changed Over Time?

Area of Science:

• Oncology
• Radiation Oncology
• Urologic Oncology

Background:

• The optimal timing and role of radiotherapy (RT) after radical prostatectomy (RP) for prostate cancer (PCa) remain subjects of debate.
• Adjuvant RT (ART) may improve recurrence-free survival in high-risk patients, but carries a significant risk of overtreatment.
• Early salvage RT (SRT), administered upon biochemical recurrence (BCR), offers a potential strategy to minimize side effects without compromising outcomes.

Purpose of the Study:

• To review current evidence on the role and timing of post-prostatectomy RT in PCa management.
• To guide multidisciplinary teams in selecting appropriate candidates for SRT versus ART.
• To highlight unresolved issues regarding patient selection, RT timing, and the role of novel diagnostics.

Main Methods:

• This is a narrative review summarizing published data on post-prostatectomy RT in PCa.
• The review synthesizes findings from randomized trials and observational studies.
• Focus is placed on comparing adjuvant and salvage RT strategies.

Main Results:

• Recent trials suggest the oncological safety of early SRT in selected PCa patients post-RP.
• Previous studies indicated ART benefits high-risk patients but leads to overtreatment in up to 40% of cases.
• Key areas requiring further clarification include patient selection criteria, optimal RT timing, and the use of hormone therapy.

Conclusions:

• Early SRT is a viable option for selected PCa patients after RP, potentially reducing overtreatment.
• Further research is needed to refine patient selection, optimize RT timing, and integrate advanced imaging and genomic data.
• A multidisciplinary approach is crucial for personalized post-prostatectomy management decisions.