Postoperative adjuvant radiotherapy - standard of care?

Background: Within 5 years following radical prostatectomy, between 15 and 60% of patients with pT3 prostate carcinomas show an increasing prostate-specific antigen (PSA) level as a sign of local and/or systemic tumor progression. Apart from a large number of retrospective investigations, results are available from 3 randomized studies.

Results: For pT3 prostate carcinomas, the data from the 3 randomized studies agree, showing a reduced biochemical progression rate after 4-5 years of around 20%. The majority of authors use total doses of 60 Gy with single doses of 2 Gy. The rate of severe late side effects is below 2%. The data for pT2 prostate carcinomas with positive margins are worse. Here, controversy exists, and further investigations are required.

Conclusions: The effectiveness of adjuvant radiotherapy for patients with pT3 tumors with positive margins with and without undetectable PSA levels is proposed. However, a survival advantage has not been demonstrated to date. For patients with positive margins in organ-limited prostate carcinomas (pT2 R1), randomized studies are recommended. It is unclear whether adjuvant radiotherapy is superior to radiotherapy for PSA levels rising out of the undetectable range after radical prostatectomy.