Radiotherapy in the Management of Prostate Cancer After Radical Prostatectomy

Abstract

The choice of treatment options for prostate cancer patients who have undergone radical prostatectomy depends on their risk profile, which is determined by the tumor node metastasis (TNM) status, histopathologic findings, and the pre- and post-radical prostatectomy PSA characteristics. The results of large clinical studies with a 10-year follow-up or more are the backbone of predictive models for risk estimates that incorporate these criteria and also for guideline recommendations. For low-to-intermediate-risk prostate cancer patients and older patients, observation with--in case of biochemical recurrence--early salvage radiotherapy can be advised after R0 resection, thus, avoiding overtreatment. After R1 resection, adjuvant radiotherapy should be considered. Patients with two or more positive lymph nodes and/or with distant metastasis may benefit from adjuvant hormone deprivation therapy. Beyond this rough outline, detailed analysis of subgroups is still required (and ongoing) to enable individually optimized treatment.

Rationale and development of image-guided intensity-modulated radiotherapy post-prostatectomy: the present standard of care?

“…Three randomized trials have addressed the significance of ART, demonstrating a near 20% absolute benefit for biochemical progression-free survival at 5 years after ART compared with a “wait and see” policy for patients with pT3± involved surgical margins. 19 – 21 Systematic reviews 22 – 25 have confirmed the benefit of ART. There are no randomized prospective studies available to prove the benefit of SRT for biochemical progression-free survival, local or systemic failure, or survival.…”

A new predictive tool for postoperative radiotherapy in prostate cancer

“…3 While radiation therapy is standard for disease recurrence, it exposes patients to potential side effects, such as impotence, radiation cystitis and proctitis, impotence, loose stools and urinary incontinence. 4 In addition, biochemical recurrence, defined as a rise in PSA after surgery or radiation, can occur without the presence of these high risk pathological traits. 5 Therefore, a means to identify the patient population most likely to benefit from radiation, while minimizing exposure to lower risk patients, would improve the current treatment paradigm for localized prostate cancer.…”