Individualization of Adjuvant Therapy After Radical Prostatectomy for Clinically Localized Prostate Cancer: Current Status and Future Directions.

Radiation therapy indications in the postprostatectomy setting are evolving. Several retrospective series have identified a number of "high-risk" pathologic features associated with an elevated risk of disease recurrence after radical prostatectomy.

More recently, several randomized phase III trials demonstrated superior biochemical relapse-free survival for adjuvant radiation therapy after prostatectomy for patients with these high-risk pathologic features, including positive margin status, extraprostatic extension, and/or seminal vesicle invasion. These series further suggested improvement in distant metastasis control and overall survival after 15 years. However, not all patients with high-risk features experience disease recurrence after surgery alone, and some subsets of patients experience suboptimal disease control and survival despite immediate postoperative radiotherapy. Furthermore, some patients without high-risk features will develop recurrence. The present review discusses the current data and potential future directions to improve individualization of therapy after prostatectomy.

Clinical genitourinary cancer. 2015 Aug 06 [Epub ahead of print]

Darrion L Mitchell, Chad R Tracy, John M Buatti, Mark C Smith, Anthony N Snow, Michael D Henry, Daniel A Vaena, Hamed H Tewfik, John M Watkins

Department of Radiation Oncology, University of Iowa Carver School of Medicine, Iowa City, IA. , Department of Urology, University of Iowa Carver School of Medicine, Iowa City, IA. , Department of Radiation Oncology, University of Iowa Carver School of Medicine, Iowa City, IA. , Department of Radiation Oncology, University of Iowa Carver School of Medicine, Iowa City, IA. , Department of Pathology, University of Iowa Carver School of Medicine, Iowa City, IA. , Department of Molecular Physiology and Biophysics and Holden Comprehensive Cancer Center, University of Iowa Carver School of Medicine, Iowa City, IA. , Department of Hematology and Oncology, University of Iowa Carver School of Medicine, Iowa City, IA. , Iowa City Cancer Treatment Center, Iowa City, IA. , Department of Radiation Oncology, University of Iowa Carver School of Medicine, Iowa City, IA. 

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