Chapter 47 - Radiotherapy After Radical Prostatectomy: Adjuvant Versus Salvage Approach

Abstract

Over 200,000 men are expected to have been diagnosed with prostate cancer in 2014. Approximately one-third will undergo radical prostatectomy and one-third of these men will have a positive margin. Another 10% are likely to have seminal vesicle invasion. Other variables that increase the patient’s risk for recurrence include high Gleason score, extracapsular extension, positive lymph nodes, and preoperative prostate-specific antigen (PSA). Some patients may also recur without those features. The potential benefit of adjuvant irradiation has been studied prospectively in men with extracapsular extension, positive surgical margins, and positive seminal vesicles. Despite level one evidence suggesting that adjuvant radiotherapy be offered to all those with high-risk features, its use has still not gained widespread acceptance among urologists. This may be due in part to concern over design flaws in the randomized trials as well as the belief that early salvage irradiation is comparable. Salvage radiotherapy has also been shown to be beneficial albeit without a randomized trial.