Adjuvant Radiotherapy Results following Radical Prostatectomy-A Critical Review

摘要

Objectives: The author attempts to better define the treatment of patients with locally advanced prostate cancer following radical prostatectomy. Methods: The data of the most recent series in the international literature have been analysed. Results: The risk of biochemical or clinical relapse in the literature is not clear. Recently, two randomised phase 3 trials have been published showing a statistical significant benefit of adjuvant irradiation with respect to biochemical and clinical progression-free survival. Toxicity of adjuvant radiotherapy was moderate in these studies. However, the range of patients with pT3 disease is large (extracapsular extension with/without positive margins, positive margins only, and seminal vesicle invasion), and the challenging question now is whether we can find a subgroup of patients with pT3 disease who will benefit most from adjuvant irradiation to prevent overtreatment for a considerable number of patients, and to reduce toxicity and costs. Conclusions: Instead of offering all patients immediate adjuvant treatment, patients with minor risk of relapse could be monitored carefully and offered salvage radiotherapy once biochemical relapse is observed.