The authors should be commended for providing an insight into salvage radiotherapy (SRT) after robotic-assisted radical prostatectomy (RARP). The retrospective study found similar incidence and efficacy of SRT in patients after RARP when compared with previous open radical prostatectomy (ORP) data. Nodal status and prostate-specific antigen (PSA) levels before SRT were independent predictors of biochemical recurrence after SRT. Most importantly, the study helps clinicians answer the question, “At what PSA level should my patients receive SRT?” According to “Grade C” evidence from the recently released ASTRO/AUA Guidelines for SRT, SRT should be offered to patients with PSA recurrence (defined as PSA ≥0.2 ng/mL) or local recurrence without evidence of distal metastasis. 1 Thompson I, Valicient R, Albertsen P, et al. American Urological Association. Radiation After Prostatectomy. Available at: https://www.auanet.org/education/guidelines/radiation-after-prostatectomy.cfm. Accessed May 10, 2013. Google Scholar Interestingly, in this cohort, men with PSA values ≤0.2 ng/mL experienced biochemical recurrence-free survival that was 2.6 years longer than men with PSAs >0.2, and 4.4 years greater for men with PSA values >1.0 ng/mL. The data supports the concept that the earlier that SRT is offered, the better the outcome. Salvage Radiotherapy After Robot-assisted Laparoscopic Radical ProstatectomyUrologyVol. 82Issue 4PreviewTo assess the incidence and efficacy of salvage radiotherapy (SRT) after robot-assisted radical prostatectomy (RARP). RARP has been linked to an increased use of adjuvant treatments. If RARP would result in an increased local recurrence rate, response rates to SRT could be expected to be better after RARP than after more conventional methods of prostatectomy. The incidence and efficacy of SRT in a RARP population were compared with nomogram prediction. Full-Text PDF ReplyUrologyVol. 82Issue 4PreviewWe thank the editor for the comments on our retrospective analysis and would like to add that with the more recent introduction of high sensitive prostate-specific antigen (PSA) assays, the decision on salvage radiotherapy after initial surgical local treatment will most likely change. Decisions of additional radiotherapy of the prostatic fossa are dependent on various factors. A rising PSA after prostatectomy is a strong indicator of disease recurrence. A rapid PSA increase has been associated with systemic disease that may obviate the need of local salvage radiotherapy. Full-Text PDF