Adjuvant or salvage radiotherapy in postoperative prostate cancer

Abstract

Prostate-specific antigen (PSA) screening increased the diagnosis of prostate cancer at a localized stage to be treated with a curative intent; approximately half of them undergo radical prostatectomy, and roughly one third of surgically treated patients are expected to experience a recurrence in 10 years' follow-up. Once PSA failure occurs, many develop distant metastases at a median of 8 years and afterward followed by cancer-related death at a median of 5 years. Biochemical failure risk after radical prostatectomy is mainly expected mostly in men with any of the following features: detectable postoperative PSA, positive surgical margins, extraprostatic extension of tumor (T3a), seminal vesicle invasion (T3b), and Gleason score ≥ 8. The radiotherapy in the undetectable PSA environment (<0.01 ng/mL) within 4 months after prostatectomy is termed as "adjuvant," while radiotherapy in rising PSA within any time after prostatectomy is defined as "salvage."