Radical prostatectomy (RP) is now the most common definitive treatment for high-risk prostate cancer. Unfortunately, many men will have residual microscopic disease after surgery alone. Despite level 1 evidence supporting the use of adjuvant radiation therapy (ART), <10% of men with adverse pathology (positive margins or T3 disease) receive ART in the USA. Early salvage radiation therapy (eSRT) at the time of biochemical recurrence has been proposed as an alternative strategy despite the lack of published randomized trials to support this approach. Multiple randomized trials are ongoing or recently completed to compare ART to eSRT, but given the long natural history of prostate cancer, long-term oncologic outcomes from these trials will not be reported for several years. In this review, we discuss the shifting trends in the diagnosis of high-risk prostate cancer given a decline in PSA screening, use of RP for high-risk disease, and compare and contrast the retrospective and randomized evidence regarding ART and SRT.
Current urology reports. 2017 Jul [Epub]
Robert T Dess, Todd M Morgan, Paul L Nguyen, Rohit Mehra, Howard M Sandler, Felix Y Feng, Daniel E Spratt
Department of Radiation Oncology, University of Michigan School of Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA., Department of Urology, University of Michigan, Ann Arbor, MI, USA., Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, MA, USA., Department of Pathology, University of Michigan, Ann Arbor, MI, USA., Department of Radiation Oncology, Cedars Sinai, Los Angeles, CA, USA., Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA., Department of Radiation Oncology, University of Michigan School of Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA. .