Post-prostatectomy radiation therapy: Updated guidelines of the Australian and New Zealand Radiation Oncology Genito-Urinary Group (FROGG)

Abstract

Over the past few years, a number of randomised controlled trials have been published addressing the management of patients with biochemical recurrence of prostate cancer post-prostatectomy. The trials sought to answer crucial questions regarding the optimal timing, prescribed dose and fractionation of post-prostatectomy radiation therapy (PPRT), as well as identifying the role for androgen deprivation (ADT) and elective pelvic lymph node irradiation. At the same time the use of novel imaging techniques such as PSMA-PET-CT scan and multi-parametric MRI of the pelvis, has increased. The Australian and New Zealand Faculty of Radiation Oncology Genito-Urinary Group (FROGG) convened a conference in September 2022 to review the latest literature and update its recommendations. This conference was attended by Australian, New Zealand and International delegates with presentations being delivered by key opinion leaders in urology, radiation oncology, medical oncology, radiation therapy and diagnostic imaging. Unresolved issues were reviewed by the FROGG working party until consensus was reached. These recommendations cover the role of PPRT, ADT and elective pelvic lymph node irradiation. Technical aspects of radiation therapy, such as clinical target volume definitions and planning techniques, which have been in place since 2008, were also updated.