The roles of adjuvant postoperative radiotherapy (RT) after radical prostatectomy, and salvage RT for apparent local-regional recurrence, are reviewed.
Postprostatectomy patients with pT3N0 disease have improved biochemical progression-free survival, clinical progression-free survival, and local-regional control after postoperative RT. Although a benefit in overall survival has not been demonstrated, patients who have a life expectancy of ≥10 years likely will have improved long-term cause-specific survival if postoperative RT is administered. The optimal postoperative RT dose is probably about 70 Gy at 2 Gy per once-daily fraction. Salvage RT should be considered for patients with local regionally recurrent cancer without distant metastasis and those with a biochemical relapse. The optimal dose probably exceeds 70 Gy, but is likely not feasible because of the risk of late toxicity. Thus, the preferred dose-fractionation schedule is approximately 70 Gy in 35 once-daily fractions.
The role of androgen deprivation therapy in combination with RT is ill defined, but it should be considered for high-risk patients. Similarly, the role for whole-pelvis RT is unclear, but it may be considered for those with a ≥20% risk of positive pelvic nodes.