pT3 Prostate Cancer: The Case for Salvage (as Opposed to Adjuvant) Radiation Therapy

Abstract

The adequate timing of radiation therapy for patients with prostate cancer with stage pT3 positive surgical margins (PSMs) at radical prostatectomy (RP) has been a long-lasting debate between the proponents of adjuvant radiation therapy (ART) in which the treatment is given on the basis of pathologic findings, and those of salvage radiation therapy (SRT), in which the treatment is given at biochemical or clinical relapse. The arguments in favor of one or the other attitude were of limited strength because they relied on nonrandomized, retrospective studies based on heterogenous patient populations. The scene dramatically changed in 2005 when three adequately powered, randomized clinical trials How then can one be presumptuous enough to argue a case apparently closed on the basis of evidence-based medicine and to make a plea for e u r o p e a n u r o l o g y s u p p l e m e n t s 6 ( 2 0 0 7 ) 5 2 1 -5 2 4 a v a i l a b l e a t w w w . s c i e n c e d i r e c t . c o m j o u r n a l h o m e p a g e : w w w . e u r o p e a n u r o l o g y . c o m Article info Keywords: Adjuvant Prostate cancer Radiation therapy Treatment Please visit www.eu-acme.org/ europeanurology to read and answer questions on-line. The EU-ACME credits will then be attributed automatically. Abstract Objectives: It is unclear as yet whether or not adjuvant treatment for radical prostatectomy achieves better oncologic results than early salvage treatment. Methods: Three recently published randomized clinical trials have shown that adjuvant radiation therapy (ART) for pT3 prostate cancer with or without positive surgical margins (PSMs) and seminal vesicle invasion (SVI) is associated with a 25-30% improvement in biochemical and clinical relapse-free survival; however, this was not translated into a significant improvement in metastatic-free and overall survival. Results: Recent studies have shown that salvage radiation therapy (SRT) given at very low levels of prostate-specific antigen (0.5-1 ng/ml) is probably as efficient as adjuvant radiation therapy given to everyone in terms of biochemical-free survival. Conclusions: A plea is made for a more selective and individualized use of radiation therapy in prostate cancer patients with pT3 disease