Salvage Versus Adjuvant Radiation Therapy Following Radical Prostatectomy in Localised Prostate Cancer: A War Without a Winner
Objective To review current literature regarding the efficacy of adjuvant radiation therapy (ART) and salvage
radiation therapy (SRT) following radical prostatectomy (RP) in patients with undetectable postoperative prostatespecific
antigen (PSA) levels and high-risk features of prostate cancer (PCa) recurrence.
Methods Seven randomized controlled trials focused on the use of ART compared with either observation or SRT
after RP that had been published in PubMed up to May 2022 were reviewed.
Results The use of ART following RP has been the treatment of choice over the past decade. Three RCTs comparing
ART with early SRT show that SRT given as soon as biochemical recurrence (BCR) is detected is not inferior to
ART while it offers the opportunity to avoid overtreatment and potential RT-related side effects. A meta-analysis
summarizing the results from these trials supports these findings.
Conclusions Early SRT may be suggested as the standard of care for patients with PCa and high-risk features for
disease recurrence following RP. Nevertheless, further investigations are needed to identify those patients who will
benefit from ART, particularly, in case of lymph node involvement. Moreover, some patients might avoid SRT despite
reaching detectable postoperative serum PSA levels.
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