What is the role of external beam radiotherapy (EBRT) after radical prostatectomy in the treatment of prostate cancer?

Updated: Aug 17, 2020
  • Author: Isamettin Andrew Aral, MD, MS; Chief Editor: Edward David Kim, MD, FACS  more...
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Radiation therapy has been used as an adjuvant after surgical treatment of prostate cancer (ie, radical prostatectomy). Selection of candidates for this approach is increasingly difficult. Prognostic variables that predict extracapsular extension can be used before the selection of surgical candidates. Unfortunately, many of the clinical trials that attempted to answer the role of postsurgical radiotherapy were conducted before the era of PSA testing.

Multi-institutional data from the American Society of Therapeutic Radiation Oncology (ASTRO) consensus conference suggest that in patients treated for a rising PSA level, postoperative radiotherapy (typically in a dose range of 60-65 Gy) offers a PSA remission rate of 70%. Unfortunately, the durability of this response varies widely from center to center, with averages ranging from 25 to 67 months. The ASTRO panel also noted that the data support initiation of therapy when the PSA level is below 1.5 ng/mL.

Subsequently reported data further support the use of adjuvant radiotherapy, indicating improved biochemical control of disease with immediate postoperative therapy as compared with benefits seen when treatment is started for a rising PSA level. Finally, the ASTRO panel noted that the use of hormonal therapy in this setting is investigational.

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