Editing Adjuvant and Salvage Radiotherapy After Prostatectomy (2019) (section)

== General ==

=== Adverse Events ===

*'''<span style="color:#ff0000">Patients should be informed of the possible short-term and long-term urinary, bowel, and sexual side effects of radiotherapy as well as of the potential benefits of controlling disease recurrence.'''
** '''<span style="color:#ff0000">Acute toxicity'''
*** '''In the immediate post-RT period of 2-3 months, mild to moderate GU and GI effects that may require the use of medication for management have been frequently reported'''
*** '''Serious toxicity effects of RT, including those requiring aggressive medication management, outpatient procedures, or hospitalization, however, are uncommon or rare,''' with most studies reporting rates of ≤5% or less.
*** The lowest acute toxicity rates have been reported with use of IMRT RT techniques.
** '''<span style="color:#ff0000">Late toxicity'''
*** '''In contrast to acute toxicities, late toxicities may manifest cumulatively for several years post-RT and persist for many years.'''
*** Patients should be informed that, similar to acute toxicities, mild to moderate late toxicities occurring > 90 days post-RT are commonly reported. Serious late toxicities, however, are relatively uncommon
*** The most common symptoms are urinary frequency (14.6%) and bleeding (8.6%). Late GI toxic effects are less common
*** '''In a small proportion of patients, late toxicities that are moderate to major may emerge for up to 4-5 years post-RT and may persist beyond that point.''' '''These toxicities are more likely to include GU symptoms than to include GI symptoms'''
** '''<span style="color:#ff0000">Urinary incontinence'''
*** '''RT is unlikely to have a major impact on UI.'''
** '''<span style="color:#ff0000">Sexual function'''
*** '''The impact of RT on erectile function in men who have already had a prostatectomy is not clear'''
** '''<span style="color:#ff0000">Other complications include urethral stricture, proctitis, and bowel movement tenderness'''
** '''<span style="color:#ff0000">Secondary malignancies'''
*** The potential for developing secondary malignancies exists when postoperative RT is given, but that studies investigating the risk of developing secondary malignancies in men undergoing prostate cancer RT are conflicting.

=== Radiation Dose ===

*'''<span style="color:#ff0000">There is insufficient evidence to recommend which RT techniques and doses produce optimal outcomes in the adjuvant and salvage context'''
** '''<span style="color:#ff0000">64-65 Gy [recall, 76-80 Gy for localized prostate cancer) is the minimum dose that should be delivered in the post-RP setting''' but decisions regarding dose should always be made by the treating physician who has full knowledge of a particular patient’s functional status, history, and tolerance for toxicity.