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Adjuvant Radiation Therapy for High-Risk Post-prostatectomy Patients

  • William C. Jackson
  • Daniel E. Spratt
  • Todd M. Morgan
Chapter

Abstract

Three randomized trials demonstrate a clinical benefit associated with adjuvant radiation therapy (ART) for men with pathologic T3 disease or a positive surgical margin following radical prostatectomy. Despite this benefit and national guidelines recommending offering ART to these men, utilization of ART remains low. While severe long-term toxicity secondary to ART is rare, there are warranted concerns of overtreatment, as many men with adverse pathologic features will never develop recurrent disease, and thereby have nothing to gain from additional therapy. As such, a selective salvage radiation approach is common for men with an undetectable PSA following prostatectomy. If this approach is taken, men should be followed closely to allow for consideration of early SRT, as the best available data suggest that SRT is most effective at PSA values <0.5 ng/mL, with continued improvement in outcomes at even lower PSA values. Certain men with high-risk features, including a persistently positive post-prostatectomy PSA, a PSA > 0.5 ng/mL, or Gleason score ≥ 8, may benefit from intensification of treatment with androgen deprivation therapy or other systemic therapies at the time of ART or SRT. Utilization of genomic classifiers is increasing as they allow for improved recurrence risk estimation following prostatectomy, and they are currently used as stratification variables in clinical trials to evaluate their ability to predict response to treatment.

Keywords

Radical prostatectomy Radiation therapy after prostatectomy Postoperative radiotherapy after radical prostatectomy Prostate-specific antigen Radiotherapy after radical prostatectomy 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • William C. Jackson
    • 1
  • Daniel E. Spratt
    • 1
  • Todd M. Morgan
    • 2
  1. 1.Department of Radiation OncologyUniversity of MichiganAnn ArborUSA
  2. 2.Department of UrologyUniversity of MichiganAnn ArborUSA

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