For Radiotherapy After Radical Prostatectomy, Salvage Therapy Should Be "Standard of Care"

By Kelly Young

Edited by David G. Fairchild, MD, MPH, and Jaye Elizabeth Hefner, MD

In men who undergo radical prostatectomy for localized or locally advanced prostate cancer, adjuvant radiotherapy doesn't seem to provide major benefits over salvage therapy and carries risk for adverse events, according to several trials and a meta-analysis in The Lancet. The authors of the meta-analysis write, "We believe early salvage radiotherapy should be considered as the standard of care."

For the meta-analysis, researchers examined three trials of over 2000 patients who had undergone radical prostatectomy. Patients were randomized to receive either adjuvant radiotherapy or salvage radiotherapy. For salvage therapy, patients could undergo radiation if their prostate-specific antigen (PSA) levels increased; about 39% of this group ultimately received radiotherapy.

Adjuvant radiotherapy didn't boost event-free survival rates — roughly 88% of patients had event-free survival at 5 years, regardless of treatment group.

In the individual trials, the other primary outcomes — freedom from distant metastases and from biochemical progression — also did not significantly favor adjuvant therapy. The trials also reported higher rates of bowel and urinary adverse events with adjuvant therapy.

Commentators write: "The four studies represent an important step forward and support the use of early salvage as opposed to adjuvant radiotherapy for many patients after radical prostatectomy." However, they "believe it is prudent" to consider adjuvant therapy for men at high risk for disease progression.