September 20, 2011
Radiation therapy following prostatectomy in high risk disease
Approximately 15-25% of patients having treatment for prostate cancer with either surgery or radiotherapy (external beam or brachytherapy) will experience a biochemical (PSA) recurrence. One of the advantages of prostatectomy is the ability to give external beam radiotherapy as an additional treatment for those with more advanced disease or positive surgical margins. There has been controversy as whether this is best delivered immediately after surgery or at the time of the rise in PSA (early or delayed)
Three phase III trials have shown a benefit from early radiotherapy with both an improved biochemical free survival and in one of the studies overall survival was improved. Similar evidence for delayed radiotherapy in randomised controlled trials for patients when the PSA has risen is lacking. There have however been trials which were not randomised that have shown benefit from delayed radiotherapy.
The decision is one that each patient should make with the help of their urologist / oncologist and key worker.