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Despite a shift of the prostate cancer disease curve to the left, toward less advanced disease, as a consequence of prostate-specific antigen (PSA)–induced stage migration, a substantial proportion of men who undergo radical prostatectomy still have extraprostatic disease as demonstrated by surgical pathology results. As of 2006, no evidence-based standard of care exists for adjuvant therapy in the management of high-risk post-prostatectomy patients, although in a European randomized study of adjuvant radiotherapy, researchers demonstrated reductions in PSA levels and local relapse rates (Lancet 2005; 366:572).
From August 1988 (the very beginning of the PSA era) to January 1997, investigators from the Southwest Oncology Group randomized 425…