Radiotherapy after radical prostatectomy

Abstract

Local treatment following radical prostatectomy used in prostate cancer patients with risk factors of recurrence or with biochemical recurrence and/or local recurrence consists of adjuvant and salvage radiotherapy. The postprostatectomy biochemical failure, according to some studies based on ten years of follow-up, is estimated at one-third of patients. It remains challenging to extract those patients who may benefit from implementing radiotherapy while minimizing the risk of overtreatment. Adjuvant radiotherapy is considered in a situation of the absence of biochemical recurrence with the presence of high-risk features in pathological staging defined as positive surgical margins (R1), extraprostatic extension (pT3a), or seminal vesicle invasion (pT3b) and Gleason score 8-10. Failure rate after RP is found approximately in 50% of men diagnosed with adverse pathologic features. It is recommended to implement adjuvant radiotherapy in case of very aggressive form of prostate cancer (pT3b, Gleason 8-10) without awaiting biochemical recurrence. However, salvage radiotherapy represents a therapeutic option for patients experiencing biochemical recurrence in case of no distant metastasis. Monitoring of serum PSA levels in each individual is crucial in deciding whether salvage radiotherapy is needed. The effectiveness of treatment increases along with early initiation of radiation therapy. Current guidelines developed by NCCN and EAU regard conversion of PSA from undetectable to detectable level as a sign of cancers’ recurrence. In addition, prostate-specific membrane antigen (PSMA) PET should be used as a part of modern imaging diagnostics for a precise determination of disease extent.