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Management of Prostate Cancer pp 173–189Cite as

Postoperative Irradiation: Immediate or Early Delayed?

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Abstract

Biochemical recurrence after radical prostatectomy (RP) is associated with risk factors including Gleason score, preoperative PSA level, tumor stage, seminal vesicle invasion, and positive surgical margins. The 5-year biochemical progression rate for patients with these characteristics has been estimated to be as high as 50–70%. Two treatment approaches for the postoperative management of these patients are adjuvant radiation therapy in men with an undetectable PSA or observation followed by early salvage radiation therapy in men with persisting or rising PSA after initially postoperative undetectable values.

Three randomized phase III trials demonstrated a nearly 20% absolute benefit for biochemical progression-free survival after adjuvant radiation therapy (ART) (60–64 Gy) compared to a “wait and see” policy. The greatest benefit has been revealed in patients with positive margins and pT3 tumors.

SRT can be offered to patients with rising PSA after RP. Of these patients, 30–70% will experience a decrease in their PSA to an undetectable range, and in about 40–50% of these patients, the PSA will remain stable after 5 years.

At the present time, there are no published randomized trials to compare ART versus SRT.

The purpose of this chapter is to review the rationale, results, and possible side effects for the two treatment approaches ART and SRT.

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  1. Department of Radiation Oncology and Radiotherapy, University Hospital Ulm, Albert-Einstein-Allee 23, Ulm, 89081, Germany

    Dirk Bottke & Thomas Wiegel

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  1. Dirk Bottke
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  2. Thomas Wiegel
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Correspondence to Thomas Wiegel .

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  1. , Department of Oncology and Radiotherapy, University Hospital, BP 217X, Grenoble, 38043, France

    Michel Bolla

  2. , Department of Urology, University Hospital, Herestraat 49, Leuven, 3000, Belgium

    Hendrik van Poppel

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Bottke, D., Wiegel, T. (2012). Postoperative Irradiation: Immediate or Early Delayed?. In: Bolla, M., van Poppel, H. (eds) Management of Prostate Cancer. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-27597-5_14

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