Current Oncology Reports

, 17:53 | Cite as

The Role of Radiotherapy After Radical Prostatectomy in Patients with Prostate Cancer

  • Giorgio GandagliaEmail author
  • Cesare Cozzarini
  • Alexandre Mottrie
  • Alberto Bossi
  • Nicola Fossati
  • Francesco Montorsi
  • Alberto Briganti
Genitourinary Cancers (DP Petrylak and JW Kim, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Genitourinary Cancers


A non-negligible proportion of prostate cancer (PCa) patients undergoing radical prostatectomy (RP) harbors aggressive disease. These individuals are at higher risk of experiencing recurrence after surgery. Results from prospective, randomized trials support the efficacy of adjuvant radiotherapy (aRT) on cancer control in selected patients with adverse disease features at RP. However, only one of these randomized trials found a significant benefit of aRT on survival. Although such a level of evidence is not currently available for salvage RT, retrospective studies demonstrated that this approach leads to excellent outcomes if administered at the earliest sign of PSA recurrence. Prognostic models might help clinicians in identifying patients who would benefit the most from adjuvant and/or salvage RT. This individualized approach would allow sparing the risk of short- and long-term toxicity in a substantial proportion of patients. Nonetheless, results from randomized trials are still awaited to compare the efficacy of (early) salvage and aRT.


Prostate cancer Radical prostatectomy Salvage radiotherapy Multi-modal treatment Adjuvant radiotherapy Androgen deprivation therapy 


Compliance with Ethics Guidelines

Conflict of Interest

Giorgio Gandaglia, Cesare Cozzarini, Alexandre Mottrie, Alberto Bossi, Nicola Fossati, Francesco Montorsi, and Alberto Briganti declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J Clin. 2015;65:5–29.CrossRefPubMedGoogle Scholar
  2. 2.
    Heidenreich A, Bastian PJ, Bellmunt J, et al. EAU guidelines on prostate cancer. part 1: screening, diagnosis, and local treatment with curative intent-update 2013. Eur Urol. 2014;65:124–37.CrossRefPubMedGoogle Scholar
  3. 3.
    Mullins JK, Feng Z, Trock BJ, Epstein JI, Walsh PC, Loeb S. The impact of anatomical radical retropubic prostatectomy on cancer control: the 30-year anniversary. J Urol. 2012;188:2219–24.CrossRefPubMedGoogle Scholar
  4. 4.
    Abdollah F, Sun M, Thuret R, et al. A competing-risks analysis of survival after alternative treatment modalities for prostate cancer patients: 1988–2006. Eur Urol. 2011;59:88–95.CrossRefPubMedGoogle Scholar
  5. 5.
    Fossati N, Passoni NM, Moschini M, et al. Impact of stage migration and practice changes on high risk prostate cancer: results from patients treated with radical prostatectomy over the last two decades. BJU Int. 2015. doi: 10.1111/bju.13125.
  6. 6.
    Pearce SM, Richards KA, Patel SG, Pariser JJ, Eggener SE. Population-based analysis of salvage radical prostatectomy with examination of factors associated with adverse perioperative outcomes. Urol Oncol. 2015;33:163.e1-6.CrossRefPubMedGoogle Scholar
  7. 7.
    Briganti A, Joniau S, Gontero P, et al. Identifying the best candidate for radical prostatectomy among patients with high-risk prostate cancer. Eur Urol. 2012;61:584–92.CrossRefPubMedGoogle Scholar
  8. 8.
    Abern MR, Terris MK, Aronson WJ, et al. The impact of pathologic staging on the long-term oncologic outcomes of patients with clinically high-risk prostate cancer. Cancer. 2014;120:1656–62.CrossRefPubMedGoogle Scholar
  9. 9.
    Joniau S, Spahn M, Briganti A, et al. Pretreatment tables predicting pathologic stage of locally advanced prostate cancer. Eur Urol. 2015;67:319–25.CrossRefPubMedGoogle Scholar
  10. 10.
    Abdollah F, Suardi N, Gallina A, et al. Extended pelvic lymph node dissection in prostate cancer: a 20-year audit in a single center. Ann Oncol. 2013;24:1459–66.CrossRefPubMedGoogle Scholar
  11. 11.
    Briganti A, Karnes RJ, Gandaglia G, et al. Natural history of surgically treated high-risk prostate cancer. Urol Oncol. 2015;33:163.e7-e13.CrossRefGoogle Scholar
  12. 12.
    Pound CR, Partin AW, Eisenberger MA, Chan DW, Pearson JD, Walsh PC. Natural history of progression after PSA elevation following radical prostatectomy. JAMA. 1999;281:1591–7.CrossRefPubMedGoogle Scholar
  13. 13.
    Freedland SJ, Humphreys EB, Mangold LA, et al. Risk of prostate cancer-specific mortality following biochemical recurrence after radical prostatectomy. JAMA. 2005;294:433–9.CrossRefPubMedGoogle Scholar
  14. 14.
    Messing EM, Manola J, Yao J, et al. Immediate versus deferred androgen deprivation treatment in patients with node-positive prostate cancer after radical prostatectomy and pelvic lymphadenectomy. Lancet Oncol. 2006;7:472–9.CrossRefPubMedGoogle Scholar
  15. 15.••
    Bolla M, van Poppel H, Tombal B, et al. Postoperative radiotherapy after radical prostatectomy for high-risk prostate cancer: long-term results of a randomised controlled trial (EORTC trial 22911). Lancet. 2012;380:2018–27. Randomized controlled trial showing that aRT reduces the risk of BCR in patients with pT3 or pT2R1 pN0 PCa.CrossRefPubMedGoogle Scholar
  16. 16.••
    Wiegel T, Bottke D, Steiner U, et al. Phase III postoperative adjuvant radiotherapy after radical prostatectomy compared with radical prostatectomy alone in pT3 prostate cancer with postoperative undetectable prostate-specific antigen: ARO 96-02/AUO AP 09/95. J Clin Oncol. 2009;27:2924–30. Randomized controlled including pT3N0 patients with an undetactable PSA after RP showing that aRT improves BCR-free survival.CrossRefPubMedGoogle Scholar
  17. 17.••
    Thompson IM, Tangen CM, Paradelo J, et al. Adjuvant radiotherapy for pathological T3N0M0 prostate cancer significantly reduces risk of metastases and improves survival: long-term followup of a randomized clinical trial. J Urol. 2009;181:956–62. Randomized controlled including pT3N0 patients demonstrating an advantage of aRT on survival as compared to initial observation.PubMedCentralCrossRefPubMedGoogle Scholar
  18. 18.
    Thompson IM, Valicenti RK, Albertsen P, et al. Adjuvant and salvage radiotherapy after prostatectomy: AUA/ASTRO Guideline. J Urol. 2013;190:441–9.CrossRefPubMedGoogle Scholar
  19. 19.
    Freedland SJ, Rumble RB, Finelli A, et al. Adjuvant and salvage radiotherapy after prostatectomy: American Society of Clinical Oncology clinical practice guideline endorsement. J Clin Oncol. 2014;32:3892–8.CrossRefPubMedGoogle Scholar
  20. 20.
    Stephenson AJ, Bolla M, Briganti A, et al. Postoperative radiation therapy for pathologically advanced prostate cancer after radical prostatectomy. Eur Urol. 2012;61:443–51.CrossRefPubMedGoogle Scholar
  21. 21.
    Pfister D, Bolla M, Briganti A, et al. Early salvage radiotherapy following radical prostatectomy. Eur Urol. 2014;65:1034–43.CrossRefPubMedGoogle Scholar
  22. 22.•
    Briganti A, Wiegel T, Joniau S, et al. Early salvage radiation therapy does not compromise cancer control in patients with pT3N0 prostate cancer after radical prostatectomy: results of a match-controlled multi-institutional analysis. Eur Urol. 2012;62:472–87. Retrospective study showing that early salvage RT leads to comparable outcomes as compared to aRT in patients with pT3N0 PCa.CrossRefPubMedGoogle Scholar
  23. 23.
    Swanson GP, Hussey MA, Tangen CM, et al. Predominant treatment failure in postprostatectomy patients is local: analysis of patterns of treatment failure in SWOG 8794. J Clin Oncol. 2007;25:2225–9.CrossRefPubMedGoogle Scholar
  24. 24.
    Terakawa T, Miyake H, Kurahashi T, Furukawa J, Takenaka A, Fujisawa M. Improved sensitivity for detecting micrometastases in pelvic lymph nodes by real-time reverse transcriptase polymerase chain reaction (RT-PCR) compared with conventional RT-PCR in patients with clinically localized prostate cancer undergoing radical prostatectomy. BJU Int. 2009;103:1074–8.CrossRefPubMedGoogle Scholar
  25. 25.
    Moschini M, Sharma V, Zattoni F, et al. Natural history of clinical recurrence patterns of lymph node-positive prostate cancer after radical prostatectomy. Eur Urol. 2015. doi: 10.1016/j.eururo.2015.03.036.
  26. 26.
    Nini A, Gandaglia G, Fossati N, et al. Patterns of clinical recurrence of node-positive prostate cancer and impact on long-term survival. Eur Urol. 2015.  10.1016/j.eururo.2015.04.035.
  27. 27.
    Suardi N, Gandaglia G, Gallina A, et al. Long-term outcomes of salvage lymph node dissection for clinically recurrent prostate cancer: results of a single-institution series with a minimum follow-up of 5 years. Eur Urol. 2015;67:299–309.CrossRefPubMedGoogle Scholar
  28. 28.•
    Wiegel T, Bartkowiak D, Bottke D, et al. Adjuvant radiotherapy versus wait-and-see after radical prostatectomy: 10-year follow-up of the ARO 96-02/AUO AP 09/95 trial. Eur Urol. 2014;66:243–50. Update of the results of the ARO 96-02/AUO trial at long-term follow-up.CrossRefPubMedGoogle Scholar
  29. 29.
    Yossepowitch O, Briganti A, Eastham JA, et al. Positive surgical margins after radical prostatectomy: a systematic review and contemporary update. Eur Urol. 2014;65:303–13.CrossRefPubMedGoogle Scholar
  30. 30.
    Mauermann J, Fradet V, Lacombe L, et al. The impact of solitary and multiple positive surgical margins on hard clinical end points in 1712 adjuvant treatment-naive pT2-4 N0 radical prostatectomy patients. Eur Urol. 2013;64:19–25.CrossRefPubMedGoogle Scholar
  31. 31.
    Carter HE, Martin A, Schofield D, et al. A decision model to estimate the cost-effectiveness of intensity modulated radiation therapy (IMRT) compared to three dimensional conformal radiation therapy (3DCRT) in patients receiving radiotherapy to the prostate bed. Radiother Oncol. 2014;112:187–93.CrossRefPubMedGoogle Scholar
  32. 32.
    Cozzarini C, Montorsi F, Fiorino C, et al. Need for high radiation dose (>or=70 gy) in early postoperative irradiation after radical prostatectomy: a single-institution analysis of 334 high-risk, node-negative patients. Int J Radiat Oncol Biol Phys. 2009;75:966–74.CrossRefPubMedGoogle Scholar
  33. 33.
    King CR, Spiotto MT. Improved outcomes with higher doses for salvage radiotherapy after prostatectomy. Int J Radiat Oncol Biol Phys. 2008;71:23–7.CrossRefPubMedGoogle Scholar
  34. 34.
    Ost P, Fonteyne V, Villeirs G, Lumen N, Oosterlinck W, De Meerleer G. Adjuvant high-dose intensity-modulated radiotherapy after radical prostatectomy for prostate cancer: clinical results in 104 patients. Eur Urol. 2009;56:669–75.CrossRefPubMedGoogle Scholar
  35. 35.
    Sineshaw HM, Gray PJ, Efstathiou JA, Jemal A. Declining use of radiotherapy for adverse features after radical prostatectomy: results from the National Cancer Data Base. Eur Urol. 2015. doi: 10.1016/j.eururo.2015.04.003.
  36. 36.
    Gandaglia G, Karakiewicz PI, Briganti A, et al. Early radiotherapy after radical prostatectomy improves cancer-specific survival only in patients with highly aggressive prostate cancer: validation of recently released criteria. Int J Urol. 2015;22:89–95.CrossRefPubMedGoogle Scholar
  37. 37.
    Sheets NC, Hendrix LH, Allen IM, Chen RC. Trends in the use of postprostatectomy therapies for patients with prostate cancer: a surveillance, epidemiology, and end results Medicare analysis. Cancer. 2013;119:3295–301.CrossRefPubMedGoogle Scholar
  38. 38.
    Maurice MJ, Zhu H, Abouassaly R. Low utilization of immediate and delayed postoperative radiation for prostate cancer with adverse pathologic features. J Urol. 2015;194:972–6.Google Scholar
  39. 39.
    Abdollah F, Boorjian S, Cozzarini C, et al. Survival following biochemical recurrence after radical prostatectomy and adjuvant radiotherapy in patients with prostate cancer: the impact of competing causes of mortality and patient stratification. Eur Urol. 2013;64:557–64.CrossRefPubMedGoogle Scholar
  40. 40.
    Daly T, Hickey BE, Lehman M, Francis DP, See AM. Adjuvant radiotherapy following radical prostatectomy for prostate cancer. Cochrane Database Syst Rev. 2011:CD007234Google Scholar
  41. 41.
    Suardi N, Gallina A, Lista G, et al. Impact of adjuvant radiation therapy on urinary continence recovery after radical prostatectomy. Eur Urol. 2014;65:546–51.CrossRefPubMedGoogle Scholar
  42. 42.
    Cozzarini C, Fiorino C, Deantoni C, et al. Higher-than-expected severe (grade 3–4) late urinary toxicity after postprostatectomy hypofractionated radiotherapy: a single-institution analysis of 1176 patients. Eur Urol. 2014;66:1024–30.CrossRefPubMedGoogle Scholar
  43. 43.
    Showalter TN, Hegarty SE, Rabinowitz C, et al. Assessing adverse events of postprostatectomy radiation therapy for prostate cancer: evaluation of outcomes in the Regione Emilia-Romagna, Italy. Int J Radiat Oncol Biol Phys. 2015;91:752–9.CrossRefPubMedGoogle Scholar
  44. 44.
    Sia M, Rodrigues G, Menard C, et al. Treatment-related toxicity and symptom-related bother following postoperative radiotherapy for prostate cancer. Can Urol Assoc J. 2010;4:105–11.PubMedCentralPubMedGoogle Scholar
  45. 45.•
    Abdollah F, Suardi N, Cozzarini C, et al. Selecting the optimal candidate for adjuvant radiotherapy after radical prostatectomy for prostate cancer: a long-term survival analysis. Eur Urol. 2013;63:998–1008. Retrospective analysis showing that aRT might improve cancer-specific survival only in selected patients with more aggressive disease characteristics.CrossRefPubMedGoogle Scholar
  46. 46.
    Den RB, Yousefi K, Trabulsi EJ, et al. Genomic classifier identifies men with adverse pathology after radical prostatectomy who benefit from adjuvant radiation therapy. J Clin Oncol. 2015;33:944–51.CrossRefPubMedGoogle Scholar
  47. 47.
    Abdollah F, Karnes RJ, Gandaglia G, Fossati N, Montorsi F, Briganti A. Reply to C.G. Rusthoven et al. J Clin Oncol. 2015;33:1989.Google Scholar
  48. 48.
    Abdollah F, Karnes RJ, Suardi N, et al. Predicting survival of patients with node-positive prostate cancer following multimodal treatment. Eur Urol. 2014;65:554–62.CrossRefPubMedGoogle Scholar
  49. 49.•
    Abdollah F, Karnes RJ, Suardi N, et al. Impact of adjuvant radiotherapy on survival of patients with node-positive prostate cancer. J Clin Oncol. 2014;32:3939–47. Multi-institutional study demonstrating a positive impact of aRT on survival in selected patients with node-positive PCa.CrossRefPubMedGoogle Scholar
  50. 50.
    Da Pozzo LF, Cozzarini C, Briganti A, et al. Long-term follow-up of patients with prostate cancer and nodal metastases treated by pelvic lymphadenectomy and radical prostatectomy: the positive impact of adjuvant radiotherapy. Eur Urol. 2009;55:1003–11.CrossRefPubMedGoogle Scholar
  51. 51.
    Rusthoven CG, Carlson JA, Kavanagh BD. External validation of the benefit of adjuvant radiotherapy for pathologic N1M0 prostate cancer. J Clin Oncol. 2015;33:1987–8.Google Scholar
  52. 52.•
    Briganti A, Karnes RJ, Joniau S, et al. Prediction of outcome following early salvage radiotherapy among patients with biochemical recurrence after radical prostatectomy. Eur Urol. 2014;66:479–86. Novel nomogram predicting the risk of recurrence in patients treated with early salvage RT.CrossRefPubMedGoogle Scholar
  53. 53.
    Stephenson AJ, Scardino PT, Kattan MW, et al. Predicting the outcome of salvage radiation therapy for recurrent prostate cancer after radical prostatectomy. J Clin Oncol. 2007;25:2035–41.PubMedCentralCrossRefPubMedGoogle Scholar
  54. 54.
    Wiegel T, Lohm G, Bottke D, et al. Achieving an undetectable PSA after radiotherapy for biochemical progression after radical prostatectomy is an independent predictor of biochemical outcome—results of a retrospective study. Int J Radiat Oncol Biol Phys. 2009;73:1009–16.CrossRefPubMedGoogle Scholar
  55. 55.
    Cotter SE, Chen MH, Moul JW, et al. Salvage radiation in men after prostate-specific antigen failure and the risk of death. Cancer. 2011;117:3925–32.CrossRefPubMedGoogle Scholar
  56. 56.
    Stephenson AJ, Shariat SF, Zelefsky MJ, et al. Salvage radiotherapy for recurrent prostate cancer after radical prostatectomy. JAMA. 2004;291:1325–32.CrossRefPubMedGoogle Scholar
  57. 57.
    King CR. The timing of salvage radiotherapy after radical prostatectomy: a systematic review. Int J Radiat Oncol Biol Phys. 2012;84:104–11.CrossRefPubMedGoogle Scholar
  58. 58.
    Spiotto MT, Hancock SL, King CR. Radiotherapy after prostatectomy: improved biochemical relapse-free survival with whole pelvic compared with prostate bed only for high-risk patients. Int J Radiat Oncol Biol Phys. 2007;69:54–61.CrossRefPubMedGoogle Scholar
  59. 59.
    Ross RW, Zietman AL, Xie W, et al. Lymphotropic nanoparticle-enhanced magnetic resonance imaging (LNMRI) identifies occult lymph node metastases in prostate cancer patients prior to salvage radiation therapy. Clin Imaging. 2009;33:301–5.CrossRefPubMedGoogle Scholar
  60. 60.
    Moghanaki D, Koontz BF, Karlin JD, et al. Elective irradiation of pelvic lymph nodes during postprostatectomy salvage radiotherapy. Cancer. 2013;119:52–60.CrossRefPubMedGoogle Scholar
  61. 61.
    Heidenreich A, Bastian PJ, Bellmunt J, et al. EAU guidelines on prostate cancer. Part II: treatment of advanced, relapsing, and castration-resistant prostate cancer. Eur Urol. 2014;65:467–79.CrossRefPubMedGoogle Scholar
  62. 62.
    Thompson Jr IM, Tangen CM, Paradelo J, et al. Adjuvant radiotherapy for pathologically advanced prostate cancer: a randomized clinical trial. JAMA. 2006;296:2329–35.CrossRefPubMedGoogle Scholar
  63. 63.
    Goenka A, Magsanoc JM, Pei X, et al. Improved toxicity profile following high-dose postprostatectomy salvage radiation therapy with intensity-modulated radiation therapy. Eur Urol. 2011;60:1142–8.CrossRefPubMedGoogle Scholar
  64. 64.
    Cozzarini C, Fiorino C, Da Pozzo LF, et al. Clinical factors predicting late severe urinary toxicity after postoperative radiotherapy for prostate carcinoma: a single-institute analysis of 742 patients. Int J Radiat Oncol Biol Phys. 2012;82:191–9.CrossRefPubMedGoogle Scholar
  65. 65.
    Sowerby RJ, Gani J, Yim H, Radomski SB, Catton C. Long-term complications in men who have early or late radiotherapy after radical prostatectomy. Can Urol Assoc J. 2014;8:253–8.PubMedCentralCrossRefPubMedGoogle Scholar
  66. 66.
    Nguyen PL, Gu X, Lipsitz SR, et al. Cost implications of the rapid adoption of newer technologies for treating prostate cancer. J Clin Oncol. 2011;29:1517–24.PubMedCentralCrossRefPubMedGoogle Scholar
  67. 67.
    Cozzarini C, Fiorino C, Di Muzio N, et al. Significant reduction of acute toxicity following pelvic irradiation with helical tomotherapy in patients with localized prostate cancer. Radiother Oncol. 2007;84:164–70.CrossRefPubMedGoogle Scholar
  68. 68.
    Alongi F, Fiorino C, Cozzarini C, et al. IMRT significantly reduces acute toxicity of whole-pelvis irradiation in patients treated with post-operative adjuvant or salvage radiotherapy after radical prostatectomy. Radiother Oncol. 2009;93:207–12.CrossRefPubMedGoogle Scholar
  69. 69.
    Poortmans P, Bossi A, Vandeputte K, et al. Guidelines for target volume definition in post-operative radiotherapy for prostate cancer, on behalf of the EORTC Radiation Oncology Group. Radiother Oncol. 2007;84:121–7.CrossRefPubMedGoogle Scholar
  70. 70.
    Zietman AL, DeSilvio ML, Slater JD, et al. Comparison of conventional-dose vs high-dose conformal radiation therapy in clinically localized adenocarcinoma of the prostate: a randomized controlled trial. JAMA. 2005;294:1233–9.CrossRefPubMedGoogle Scholar
  71. 71.
    Bernard Jr JR, Buskirk SJ, Heckman MG, et al. Salvage radiotherapy for rising prostate-specific antigen levels after radical prostatectomy for prostate cancer: dose–response analysis. Int J Radiat Oncol Biol Phys. 2010;76:735–40.CrossRefPubMedGoogle Scholar
  72. 72.
    Briganti A, Joniau S, Gandaglia G, et al. Patterns and predictors of early biochemical recurrence after radical prostatectomy and adjuvant radiation therapy in men with pT3N0 prostate cancer: implications for multimodal therapies. Int J Radiat Oncol Biol Phys. 2013;87:960–7.CrossRefPubMedGoogle Scholar
  73. 73.
    Roach 3rd M, DeSilvio M, Lawton C, et al. Phase III trial comparing whole-pelvic versus prostate-only radiotherapy and neoadjuvant versus adjuvant combined androgen suppression: Radiation Therapy Oncology Group 9413. J Clin Oncol. 2003;21:1904–11.CrossRefPubMedGoogle Scholar
  74. 74.
    Mohiuddin JJ, Baker BR, Chen RC. Radiotherapy for high-risk prostate cancer. Nat Rev Urol. 2015;12:145–54.CrossRefPubMedGoogle Scholar
  75. 75.
    Jackson WC, Schipper MJ, Johnson SB, et al. Duration of androgen deprivation therapy influences outcomes for patients receiving radiation therapy following radical prostatectomy. Eur Urol. 2015. doi: 10.1016/j.eururo.2015.05.009.
  76. 76.
    Krauss D, Kestin L, Ye H, et al. Lack of benefit for the addition of androgen deprivation therapy to dose-escalated radiotherapy in the treatment of intermediate- and high-risk prostate cancer. Int J Radiat Oncol Biol Phys. 2011;80:1064–71.CrossRefPubMedGoogle Scholar
  77. 77.
    Fossati N, Karnes RJ, Cozzarini C, et al. Impact of pre-treatment PSA level on cancer control after early salvage radiation therapy post radical prostatectomy: need for patient stratification according to prostate cancer features. J Urol. 2015;193, e1089.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Giorgio Gandaglia
    • 1
    • 2
    Email author
  • Cesare Cozzarini
    • 3
  • Alexandre Mottrie
    • 2
    • 4
  • Alberto Bossi
    • 5
  • Nicola Fossati
    • 1
  • Francesco Montorsi
    • 1
  • Alberto Briganti
    • 1
  1. 1.Unit of Urology/Division of Oncology, URIIRCCS Ospedale San RaffaeleMilanItaly
  2. 2.OLV Vattikuti Robotic Surgery InstituteMelleBelgium
  3. 3.Department of RadiotherapyIRCCS Ospedale San RaffaeleMilanItaly
  4. 4.Department of UrologyOnze-Lieve-Vrouw HospitalAalstBelgium
  5. 5.Department of Radiation OncologyInstitut Gustave RoussyVillejuifFrance

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