Adjuvant radiotherapy results following radical prostatectomy - A critical review

Objectives: The author attempts to better define the treatment of patients with locally advanced prostate cancer following radical prostatectomy. Methods: The data of the most recent series in the international literature have been analysed. Results: The risk of biochemical or clinical relapse in the literature is not clear. Recently, two randomised phase 3 trials have been published showing a statistical significant benefit of adjuvant irradiation with respect to biochemical and clinical progression-free survival. Toxicity of adjuvant radiotherapy was moderate in these studies. However, the range of patients with pT3 disease is large (extracapsular extension with/without positive margins, positive margins only, and seminal vesicle invasion), and the challenging question now is whether we can find a subgroup of patients with pT3 disease who will benefit most from adjuvant irradiation to prevent overtreatment for a considerable number of patients, and to reduce toxicity and costs. Conclusions: Instead of offering all patients immediate adjuvant treatment, patients with minor risk of relapse could be monitored carefully and offered salvage radiotherapy once biochemical relapse is observed. (c) 2007 European Association of Urology. Published by Elsevier B.V. All rights reserved