Indications and timing of radiotherapy after radical prostatectomy: An update -

Abstract

Recently reported trials have shed light on the vexing clinical dilemma of the optimal timing and indications of radiation (RT) following prostatectomy (RP) for carcinoma of the prostate (CaP). The importance of this work can’t be overemphasised since recurrence is common, occurring in up to 50% of patients within 10 years, depending on the type of primary therapy and stage of cancer.¹

The controversy of timing and indications arose following the publication of a landmark 2009 paper by Thompson et al.2 Their work provided a strong signal in favour of adjuvant RT therapy. This trial randomised patients with high-risk prostate cancer to either immediate adjuvant RT (immediate defined as within four months, 60–64Gy) or observation. The key finding was a median 1.7-year survival benefit in the adjuvant group. Prior studies had shown reduction in biochemical recurrence, but no improvement in metastasis-free status or survival. At the time, this outcome was practice-changing.