The American Society of Clinical Oncology (ASCO) issued an endorsement of the American Urological Association (AUA)/American Society for Radiation Oncology (ASTRO) guidelines on the use of adjuvant and salvage radiotherapy after prostatectomy, which was based on a systematic review of medical literature.
The guideline recommends that “physicians discuss the role of radiation therapy with patients who have adverse pathologic findings at prostatectomy (ie, seminal vesicle invasion, extensive positive surgical margins) and salvage radiation therapy with patients with detectable postoperative prostate-specific antigen (PSA) or local recurrence after prostatectomy. Patients should be informed that, although adjuvant radiotherapy reduces the risk of recurrence and disease progression, its impact on preventing metastases and extending survival is less clear.”
It is important for patients to understand that not all men who are candidates for adjuvant or salvage radiotherapy have the same risk of recurrence or disease progression, and thus, not all men will derive the same benefit from radiotherapy. Individuals at the highest risk for cancer recurrence after radical prostatectomy (including men with seminal vesicle invasion, Gleason score 8 to 10, extensive positive margins, and detectable postoperative PSA) are likely to derive the greatest benefit. Individuals should make sure they discuss the potential role of radiation with their treating physician.