EURURO Vol. 72 No. 5

694 860

3.6. sRT: rationale, effectiveness, and optimal timing
sRT is defined as the administration of postoperative RT to
the prostatic bed the surrounding tissues in patients who
experience BCR after surgery The availability of postop-
erative PSA levels as a reliable marker of recurrence after RP
enables prompt identification of patients with BCR who are at
increased risk of developing metastases and dying from PCa
. The administration of sRT to these patients is justified
primarily because it is the only curative option, although some
would argue their preference for its use over aRT in an effort to
reduce costs and the risk of treatment-related side effects
. Few prospective randomized trials are available evaluat-
ing the oncologic benefits of sRT (ie, RTOG 9601 and GETUG-
AFU-16) Randomized studies assessing the impact of
aRT on survival in patients with adverse characteristics were
not initially designed to compare immediate RT versus
observation followed by sRT . Indeed, the lack of
standardized treatment protocols in the case of recurrence,
where only less than 50% of patients experiencing recurrence
in the control arm of these studies received sRT, precludes an
unbiased comparison between the two approaches. In addi-
tion, these patients were treated at relatively high PSA levels
and with heterogeneous techniques, doses, and protocols
. Consequently, the available data is neither complete nor
contemporary. It is however the best available currently for
sRT decision making in patients with delayed local recurrence
after RP.
depicts the characteristics of 21 retrospective
studies describing the outcomes of sRT Recent
investigations report 5-yr BCR- and metastases-free surviv-
al rates of 50–58% and 86–92%, respectively. A large study
evaluating more than 1100 patients described the long-
term outcomes of sRT, where the BCR- and metastasis-free
survival rates were 35% and 80% at 10-yr follow-up The
fact that only one out of three patients is free from
recurrence at 10-yr after sRT highlights the need for more
aggressive salvage strategies and/or earlier treatments.
Refinements in patient selection criteria, doses, and
techniques might improve the outcomes of postoperative
Table 2 – Selected retrospective studies evaluating the role of adjuvant radiotherapy (aRT) in node-positive prostate cancer (PCa) patients
Patients (N) aRT
definition
Technique Dose
(median)
Study
period
Follow-up
(median)
Outcomes
Briganti et al 171 pts treated with
aRT + aHT vs 532 pts
with aHT alone
NA Conventional
nonconformal
treatment or
3D-CRT
68.4 Gy 1988–2003 95.1 mo Patients treated with aRT
had higher CSS rates
compared with those treated
with aHT alone at 10-yr
follow-up (86% vs 70%;
p = 0.004)
Kaplan et al 177 pts treated with
aRT vs 400 pts
without aRT
RT <1 yr
from surgery
NA NA 1995–2007 NA aRT was not associated with
an improvement in overall
and CSS
Abdollah et al 386 pts treated with
aRT + aHT vs 721 pts
with aHT alone
RT within
90 d from RP
Conventional
nonconformal
treatment or
3D-CRT
68.4 Gy 1988–2010 7.1 yr aRT associated with
improved OS at 8-yr follow-
up (87.6% vs 75.1%;
p < 0.001)
aRT improved survival only
in men with 2 or fewer
positive nodes and high-
grade PCa or nonorgan
confined disease and those
with 3–4 positive nodes
Rusthoven et al 420 pts treated with
aRT vs 1287 pts
without aRT
NA NA NA 2004–2009 NA aRT improved survival only
in men with 2 or less
positive nodes and high-
grade PCa or nonorgan
confined disease
Wong et al 3636 pts treated
without adjuvant
treatments vs 2041
with aHT vs 350 with
aRT vs 1198 with
aRT + aHT
NA NA NA 2004–2011 46 mo The 5-yr OS rates were 85.2%
for no adjuvant therapy,
82.9% for aHT, 88.3% for aRT,
and 88.8% for aRT + aHT
(p < 0.001)
Tilki et al 213 pts treated with
aRT vs 505 pts treated
with observation sRT
vs 55 pts treated with aHT
NA 3D-CRT to the
prostatic and
seminal vesicle
bed + pelvic area
60–70 Gy
to the
prostatic bed
and 50 Gy to
the pelvis
2005–2013 33.8 mo The 4-yr metastasis-free
survival rateswere 82.5% vs
91.8% for observation sRT
vs aRT (p = 0.02)
aRT significantly reduced the
risk of BCR and metastases
when compared with aHT
alone or observation sRT
aHT: = adjuvant hormonal treatment; CSS = cancer-specific survival; OS = overall survival; PSA = prostate specific antigen; pts = patients; RP = radical
prostatectomy; RT = radiotherapy; sRT = salvage radiotherapy; WS = wait-and-see; 3D-CRT = three-dimensional conformal approach.
E U R O P E A N U R O L O G Y 7 2 ( 2 0 1 7 ) 6 8 9 – 7 0 9 694