Adjuvant radiotherapy after radical prostatectomy

Background:Within 5 years following radical prostatectomy, between 15 and 60% of patients with pT3 prostate carcinomas show an increasing prostate specific antigen (PSA)as a sign of local and/or systemic tumour progression. Adjuvant radiotherapy (RT)for positive margins (R1)aims to reduce residual tumour cells in the prostatic bed, thus possibly reducing the biochemical progression rate. Apart from a large number of retrospective investigations, available results are presented from three randomised studies which have either been published completely (or in abstract form).Results:For pT3 prostate carcinomas, agreeing data are presented from three randomised studies, which show around a 20% reduced biochemical progression rate (bNED)after 4 to 5 years. With these data the results of numerous retrospective studies were conformed. The majority of the authors used total doses of 60 Gy. From one randomised study an increased local control rate was demonstrated as basis for the extended freedom of biochemical progression. The rate of acute and late side effects after three dimensional (3-D)planned radiotherapy with 60 Gy is very small and the rate of severe side effects is below 2%. The data situation for pT2 prostate carcinomas with positive margins is worse. Here, controversial data are presented, which require further investigation. Only retrospective data demonstrated a 25% advantage for adjuvant RT. Therefore, adjuvant radiotherapy also seems reasonable for pT-2 carcinomas with positive margins.Conclusions:The effectiveness of adjuvant radiotherapy for patients with pT-3 tumours with positive margins with and without undetectable PSA levels with 60 Gy total dose has been demonstrated. A survival advantage has not been shown until now. 3-D treatment planning remains the standard technique for these patients.For patients with positive margins in organ-limited prostate carcinomas (pT2 R 1)randomised studies are recommended.It remains unclear whether the adjuvant RT is superior to the radiotherapy for rising PSA levels out of the undetectable range after radical prostatectomy.