pT3 Prostate Cancer: The Case for Salvage (as Opposed to Adjuvant) Radiation Therapy

ObjectivesIt is unclear as yet whether or not adjuvant treatment for radical prostatectomy achieves better oncologic results than early salvage treatment.MethodsThree recently published randomized clinical trials have shown that adjuvant radiation therapy (ART) for pT3 prostate cancer with or without positive surgical margins (PSMs) and seminal vesicle invasion (SVI) is associated with a 25–30% improvement in biochemical and clinical relapse-free survival; however, this was not translated into a significant improvement in metastatic-free and overall survival.ResultsRecent studies have shown that salvage radiation therapy (SRT) given at very low levels of prostate-specific antigen (0.5–1 ng/ml) is probably as efficient as adjuvant radiation therapy given to everyone in terms of biochemical-free survival.ConclusionsA plea is made for a more selective and individualized use of radiation therapy in prostate cancer patients with pT3 disease.