Postoperative Radiotherapy of Prostate Cancer: Adjuvant versus Early Salvage.

Results of three randomized clinical trials (RCTs) comparing adjuvant radiotherapy (ART) and early salvage radiotherapy (eSRT) of prostate carcinoma and a subsequent meta-analysis of the individual patient data from these RCTs were recently published. The results suggest that early eSRT is as effective and potentially less toxic than ART. Therefore, eSRT should be considered the standard of care. However, due to limitations in the RCTs, ART remains a valid treatment option in patients with the combination of high-risk features such as Gleason Score (GS) 8-10, positive surgical margins (R1) and pathological T-stage 3 or 4 (pT3/4). This article provides a critical appraisal of the RCTs and the rationale for recommendations adopted in the current national guidelines regarding patients with high-risk features after radical prostatectomy (RP): ART should be offered in case of pT3/pT4 and R1 and Gleason Score 8-10; ART can be offered in case of pT3/pT4 and R0 and Gleason Score 8-10 as well as in case of multifocal R1 (including pT2) and Gleason Score 8-10. In any case, the alternative treatment option of eSRT in case of rising PSA should be discussed with the patient.

Biomedicines. 2022 Sep 12*** epublish ***

Daniel Wegener, Daniel M Aebersold, Marc-Oliver Grimm, Peter Hammerer, Michael Froehner, Markus Graefen, Dirk Boehmer, Daniel Zips, Thomas Wiegel

Department of Radiation Oncology, University Hospital Tuebingen, 72076 Tuebingen, Germany., Department of Radiation Oncology, Inselspital Bern University Hospital, University of Bern, 3012 Bern, Switzerland., Department of Urology, Jena University Hospital, 07743 Jena, Germany., Department of Urology, University Hospital Braunschweig, 38106 Braunschweig, Germany., Department of Urology, Zeisigwaldkliniken Bethanien Chemnitz, 09130 Chemnitz, Germany., Martini Clinic, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany., Department of Radiation Oncology, Charité University Medicine Berlin, 10117 Berlin, Germany., Department of Radiation Oncology, University Hospital Ulm, 89081 Ulm, Germany.

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