Postprostatectomy Radiation Therapy for Prostate Cancer

Radical prostatectomy is the most common initial treatment for prostate cancer. Patients with high-risk pathologic features, such as a positive margin or seminal vesicle involvement, have a 40% to 50% risk of developing biochemical failure at some point in the future. Radiotherapy to the prostate bed has been used both adjuvantly and for salvage. There continues to be an active debate regarding when radiation should be administered, although 3 recent randomized trials show a consistent improvement in biochemical failure when adjuvant radiotherapy is administered as compared with radical prostatectomy alone. Because the morbidity of postoperative radiotherapy is relatively low, when pathologic high risk factors are present adjuvant radiotherapy should be considered. The role of androgen deprivation postprostatectomy is less well defined.