Postoperative management of prostate cancer—optimizing prostate cancer care

Abstract

The current standard-of-care follow-up protocol for patients who have undergone a radical prostatectomy—irrespective of prostatectomy (p) stage, margin status, or Gleason score—is monitoring with an ultrasensitive prostate-specific antigen (PSA) test and the initiation of salvage radiation therapy (RT) if the PSA level reaches or exceeds 0.1 ng/mL (to convert PSA to µg/L, multiply by 1). This practice is supported by a meta-analysis of 3 prospective randomized clinical trials (RCTs), which derived its conclusion from examination of the end point of progression-free survival (PFS), primarily influenced by PSA failure. However, it is important to note that the primary end point of the RADICALS-RT trial, the largest of the 3 RCTs included in this meta-analysis, was freedom from distant metastases (FFDM). However, as the other 2 RCTs approached the reporting of their primary end point, being PFS, a decision was made to consolidate the data and evaluate PFS, even though it was a secondary end point in the RADICALS-RT study.