Adjuvant and Salvage Radiotherapy After Prostatectomy (2019): Difference between revisions

**Observational studies suggest that ART patients generally have better outcomes compared to SRT patients. However, this is difficult to compare these groups that SRT studies focus only on patients who have already relapsed and the ART group has patients that were never destined to recur

* '''Patients who undergo RP for localized prostate cancer should be informed of the potential for adverse pathologic findings that increase risk of cancer recurrence and that these findings may suggest a potential benefit of additional therapy after surgery.'''

** '''The risk of recurrence is greater among men with adverse pathology, such as positive surgical margins, seminal vesicle invasion, extraprostatic extension, and higher Gleason scores'''

** Rates of recurrence in post-RP patients with adverse pathological features may be > 60% at 5 years post-RP

== Salvage Radiotherapy ==

* '''Patients should be informed that the development of a PSA recurrence after surgery is associated with a higher risk of development of metastasis or death from prostate cancer. PSA monitoring after radical prostatectomy should be done regularly to enable early administration of salvage therapies if appropriate.'''

** Pound et al. were among the first to describe the time course of disease progression. They followed 1997 consecutive men undergoing RP at the Johns Hopkins Hospital and demonstrated that no man experienced either distant or local recurrence without also demonstrating a rising PSA level. Among 304 men who developed detectable PSA values following surgery, the median time to the development of metastases was 8 years. Men who developed metastatic disease usually died at median 5 years later. The median PSADT provided the most statistically significant prediction of time to distant progression. Men with a PSADT < 10 months usually developed metastases within 5 years of surgery, while men with a PSADT > 10 months developed metastases much later.

== General ==

*** '''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.

*** '''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'''

*** '''RT is unlikely to have a major impact on UI.'''

*** '''The impact of RT on erectile function in men who have already had a prostatectomy is not clear'''

*** 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.

== Future trials ==