Adjuvant and Salvage Radiation Therapy for Prostate Cancer After Radical Prostatectomy

  • Joo Hwan Lee
  • Sung Hwan KimEmail author


Although radical prostatectomy (RP) provides excellent cancer control, tumor recurrence occurred in approximately 15–40% of patients within 5 years usually with elevated prostate-specific antigen (PSA) level [1, 2]. Postoperative radiation therapy is recommended for patients with adverse risk factors after complete surgical resection, subclinical disease detected by elevated postoperative serum PSA, or clinical tumor recurrence in prostatic fossa.


  1. 1.
    Lepor H. Radical retropubic prostatectomy. Urol Clin North Am. 2001;28(3):509–19, viiiCrossRefPubMedGoogle Scholar
  2. 2.
    Ward JF, Moul JW. Rising prostate-specific antigen after primary prostate cancer therapy. Nat Clin Pract Urol. 2005;2(4):174–82.CrossRefPubMedGoogle Scholar
  3. 3.
    Valicenti RK, Thompson I Jr, Albertsen P, Davis BJ, Goldenberg SL, Wolf JS, et al. Adjuvant and salvage radiation therapy after prostatectomy: American Society for Radiation Oncology/American Urological Association guidelines. Int J Radiat Oncol Biol Phys. 2013;86(5):822–8.CrossRefPubMedGoogle Scholar
  4. 4.
    Thompson IM Jr, Tangen CM, Paradelo J, Lucia MS, Miller G, Troyer D, et al. Adjuvant radiotherapy for pathologically advanced prostate cancer: a randomized clinical trial. JAMA. 2006;296(19):2329–35.CrossRefPubMedGoogle Scholar
  5. 5.
    Thompson IM, Valicenti RK, Albertsen P, Davis BJ, Goldenberg SL, Hahn C, et al. Adjuvant and salvage radiotherapy after prostatectomy: AUA/ASTRO Guideline. J Urol. 2013;190(2):441–9.CrossRefPubMedGoogle Scholar
  6. 6.
    Bolla M, van Poppel H, Tombal B, Vekemans K, Da Pozzo L, de Reijke TM, 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(9858):2018–27.CrossRefPubMedGoogle Scholar
  7. 7.
    Bolla M, van Poppel H, Collette L, van Cangh P, Vekemans K, Da Pozzo L, et al. Postoperative radiotherapy after radical prostatectomy: a randomised controlled trial (EORTC trial 22911). Lancet. 2005;366(9485):572–8.CrossRefPubMedGoogle Scholar
  8. 8.
    Wiegel T, Bartkowiak D, Bottke D, Bronner C, Steiner U, Siegmann A, 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(2):243–50.CrossRefPubMedGoogle Scholar
  9. 9.
    Wiegel T, Bottke D, Steiner U, Siegmann A, Golz R, Storkel S, 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(18):2924–30.CrossRefPubMedGoogle Scholar
  10. 10.
    Thompson IM, Tangen CM, Paradelo J, Lucia MS, Miller G, Troyer D, 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(3):956–62.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Daly T, Hickey BE, Lehman M, Francis DP, See AM. Adjuvant radiotherapy following radical prostatectomy for prostate cancer. Cochrane Database Syst Rev. 2011(12):Cd007234.Google Scholar
  12. 12.
    Shaikh MP, Alite F, Wu MJ, Solanki AA, Harkenrider MM. Adjuvant radiotherapy versus wait-and-see strategy for pathologic T3 or margin-positive prostate cancer: a meta-analysis. Am J Clin Oncol. 2017.Google Scholar
  13. 13.
    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(4):669–75.CrossRefPubMedGoogle Scholar
  14. 14.
    Cozzarini C, Montorsi F, Fiorino C, Alongi F, Bolognesi A, Da Pozzo LF, 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(4):966–74.CrossRefPubMedGoogle Scholar
  15. 15.
    De Meerleer G, Fonteyne V, Meersschout S, Van den Broecke C, Villeirs G, Lumen N, et al. Salvage intensity-modulated radiotherapy for rising PSA after radical prostatectomy. Radiother Oncol. 2008;89(2):205–13.CrossRefPubMedGoogle Scholar
  16. 16.
    Albertsen PC, Hanley JA, Penson DF, Fine J. Validation of increasing prostate specific antigen as a predictor of prostate cancer death after treatment of localized prostate cancer with surgery or radiation. J Urol. 2004;171(6 Pt 1):2221–5.CrossRefPubMedGoogle Scholar
  17. 17.
    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(17):1591–7.CrossRefPubMedGoogle Scholar
  18. 18.
    Trock BJ, Han M, Freedland SJ, Humphreys EB, DeWeese TL, Partin AW, et al. Prostate cancer-specific survival following salvage radiotherapy vs observation in men with biochemical recurrence after radical prostatectomy. JAMA. 2008;299(23):2760–9.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Boorjian SA, Karnes RJ, Crispen PL, Rangel LJ, Bergstralh EJ, Blute ML. Radiation therapy after radical prostatectomy: impact on metastasis and survival. J Urol. 2009;182(6):2708–14.CrossRefPubMedGoogle Scholar
  20. 20.
    Cotter SE, Chen MH, Moul JW, Lee WR, Koontz BF, Anscher MS, et al. Salvage radiation in men after prostate-specific antigen failure and the risk of death. Cancer. 2011;117(17):3925–32.CrossRefPubMedGoogle Scholar
  21. 21.
    Stephenson AJ, Scardino PT, Kattan MW, Pisansky TM, Slawin KM, Klein EA, et al. Predicting the outcome of salvage radiation therapy for recurrent prostate cancer after radical prostatectomy. J Clin Oncol. 2007;25(15):2035–41.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    King CR. The timing of salvage radiotherapy after radical prostatectomy: a systematic review. Int J Radiat Oncol Biol Phys. 2012;84(1):104–11.CrossRefPubMedGoogle Scholar
  23. 23.
    King CR. The dose-response of salvage radiotherapy following radical prostatectomy: A systematic review and meta-analysis. Radiother Oncol. 2016;121(2):199–203.CrossRefPubMedGoogle Scholar
  24. 24.
    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(1):54–61.CrossRefPubMedGoogle Scholar
  25. 25.
    Moghanaki D, Koontz BF, Karlin JD, Wan W, Mukhopadhay N, Hagan MP, et al. Elective irradiation of pelvic lymph nodes during postprostatectomy salvage radiotherapy. Cancer. 2013;119(1):52–60.CrossRefPubMedGoogle Scholar
  26. 26.
    Shipley WU, Seiferheld W, Lukka HR, Major PP, Heney NM, Grignon DJ, et al. Radiation with or without Antiandrogen Therapy in Recurrent Prostate Cancer. N Engl J Med. 2017;376(5):417–28.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Carrie C, Hasbini A, de Laroche G, Richaud P, Guerif S, Latorzeff I, et al. Salvage radiotherapy with or without short-term hormone therapy for rising prostate-specific antigen concentration after radical prostatectomy (GETUG-AFU 16): a randomised, multicentre, open-label phase 3 trial. Lancet Oncol. 2016;17(6):747–56.CrossRefPubMedGoogle Scholar
  28. 28.
    Parker C, Sydes MR, Catton C, Kynaston H, Logue J, Murphy C, et al. Radiotherapy and androgen deprivation in combination after local surgery (RADICALS): a new Medical Research Council/National Cancer Institute of Canada phase III trial of adjuvant treatment after radical prostatectomy. BJU Int. 2007;99(6):1376–9.CrossRefPubMedGoogle Scholar
  29. 29.
    Ku JY, Lee CH, Ha HK. Long-term oncologic outcomes of postoperative adjuvant versus salvage radiotherapy in prostate cancer: Systemic review and meta-analysis of 5-year and 10-year follow-up data. Korean J Urol. 2015;56(11):735–41.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Fossati N, Karnes RJ, Boorjian SA, Moschini M, Morlacco A, Bossi A, et al. Long-term impact of adjuvant versus early salvage radiation therapy in pT3N0 prostate cancer patients treated with radical prostatectomy: results from a multi-institutional series. Eur Urol. 2017;71(6):886–93.CrossRefPubMedGoogle Scholar
  31. 31.
    Pearse M, Fraser-Browne C, Davis ID, Duchesne GM, Fisher R, Frydenberg M, et al. A Phase III trial to investigate the timing of radiotherapy for prostate cancer with high-risk features: background and rationale of the Radiotherapy -- Adjuvant Versus Early Salvage (RAVES) trial. BJU Int. 2014;113(Suppl 2):7–12.CrossRefPubMedGoogle Scholar
  32. 32.
    Feng M, Hanlon AL, Pisansky TM, Kuban D, Catton CN, Michalski JM, et al. Predictive factors for late genitourinary and gastrointestinal toxicity in patients with prostate cancer treated with adjuvant or salvage radiotherapy. Int J Radiat Oncol Biol Phys. 2007;68(5):1417–23.CrossRefPubMedGoogle Scholar
  33. 33.
    Goldin GH, Sheets NC, Meyer AM, Kuo TM, Wu Y, Sturmer T, et al. Comparative effectiveness of intensity-modulated radiotherapy and conventional conformal radiotherapy in the treatment of prostate cancer after radical prostatectomy. JAMA Intern Med. 2013;173(12):1136–43.CrossRefPubMedGoogle Scholar
  34. 34.
    Goenka A, Magsanoc JM, Pei X, Schechter M, Kollmeier M, Cox B, et al. Improved toxicity profile following high-dose postprostatectomy salvage radiation therapy with intensity-modulated radiation therapy. Eur Urol. 2011;60(6):1142–8.CrossRefPubMedGoogle Scholar
  35. 35.
    Ghadjar P, Hayoz S, Bernhard J, Zwahlen DR, Holscher T, Gut P, et al. Acute toxicity and quality of life after dose-intensified salvage radiation therapy for biochemically recurrent prostate cancer after prostatectomy: first results of the randomized trial SAKK 09/10. J Clin Oncol. 2015;33(35):4158–66.CrossRefPubMedGoogle Scholar

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© Springer Nature Singapore Pte Ltd. 2018

Authors and Affiliations

  1. 1.Department of Radiation OncologySt. Vincent Hospital, College of Medicine, The Catholic University of KoreaSeoulSouth Korea

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