Immediate Versus Salvage Postoperative Radiotherapy in High-Risk Prostate Cancer Patients: A Critical Review

Radical prostatectomy in high-risk prostate cancer patients has long been followed by immediate adjuvant radiotherapy (IART) to increase biochemical relapse-free survival. However, the increased urinary and digestive radio-induced toxicities have raised questions about the safety of delaying radiotherapy until the occurrence of biochemical or clinical relapse. Recently, early salvage radiotherapy (ESRT) has been compared to IART, and results found equivalence in terms of efficiency outcomes, but increased toxicity was noted in patients receiving IART, leading to the proposal of ESRT as the new standard of care in high-risk patients after surgery. However, several confounding points are discussed in the present review regarding the methodology and results of these recent trials. Further follow-up is necessary to detect possible long-term advantages of one radiotherapy timing over the other.