Adjuvant and salvage radiotherapy after prostatectomy: American Society of Clinical Oncology clinical practice guideline endorsement - Abstract

PURPOSE: To endorse the American Urological Association (AUA)/American Society for Radiation Oncology (ASTRO) guideline on adjuvant and salvage radiotherapy after prostatectomy.

The American Society of Clinical Oncology (ASCO) has a policy and set of procedures for endorsing clinical practice guidelines developed by other professional organizations.

METHODS: The guideline on adjuvant and salvage radiotherapy after prostatectomy was reviewed for developmental rigor by methodologists. An ASCO endorsement panel then reviewed the content and recommendations.

RESULTS: The panel determined that the guideline recommendations on adjuvant and salvage radiotherapy after prostatectomy, published in August 2013, are clear, thorough, and based on the most relevant scientific evidence. ASCO endorsed the guideline on adjuvant and salvage radiotherapy after prostatectomy, adding one qualifying statement that not all candidates for adjuvant or salvage radiotherapy have the same risk of recurrence or disease progression, and thus, risk-benefit ratios are not the same for all men. Those at the highest risk for recurrence after radical prostatectomy include men with seminal vesicle invasion, Gleason score 8 to 10, extensive positive margins, and detectable postoperative prostate-specific antigen (PSA).

RECOMMENDATIONS: Physicians should discuss adjuvant radiotherapy with patients with adverse pathologic findings at prostatectomy (ie, seminal vesicle invasion, positive surgical margins, extraprostatic extension) and salvage radiotherapy with patients with PSA or local recurrence after prostatectomy. The discussion of radiotherapy should include possible short- and long-term adverse effects and potential benefits. The decision to administer radiotherapy should be made by the patient and multidisciplinary treatment team, keeping in mind that not all men are at equal risk of recurrence or clinically meaningful disease progression. Thus, the risk-benefit ratio will differ for each patient.

Written by:
Freedland SJ, Rumble RB, Finelli A, Chen RC, Slovin S, Stein MN, Mendelson DS, Wackett C, Sandler HM.   Are you the author?
Duke University, Durham; University of North Carolina, Chapel Hill, NC; American Society of Clinical Oncology, Alexandria, VA; Princess Margaret Hospital, University Health Network, Toronto; Patient Advocate, Orillia, Ontario, Canada; Memorial Sloan Kettering Cancer Center, New York, NY; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Pinnacle Oncology Hematology, Scottsdale, AZ; Cedars-Sinai Medical Center, Los Angeles, CA.

Reference: J Clin Oncol. 2014 Dec 1;32(34):3892-8.
doi: 10.1200/JCO.2014.58.8525

PubMed Abstract
PMID: 25366677 Prostate Cancer Section