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Adjuvant Radiation Therapy for High-Risk Post-prostatectomy Patients

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Prostate Cancer

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Abstract

Three randomized trials demonstrate a clinical benefit associated with adjuvant radiation therapy (ART) for men with pathologic T3 disease or a positive surgical margin following radical prostatectomy. Despite this benefit and national guidelines recommending offering ART to these men, utilization of ART remains low. While severe long-term toxicity secondary to ART is rare, there are warranted concerns of overtreatment, as many men with adverse pathologic features will never develop recurrent disease, and thereby have nothing to gain from additional therapy. As such, a selective salvage radiation approach is common for men with an undetectable PSA following prostatectomy. If this approach is taken, men should be followed closely to allow for consideration of early SRT, as the best available data suggest that SRT is most effective at PSA values <0.5 ng/mL, with continued improvement in outcomes at even lower PSA values. Certain men with high-risk features, including a persistently positive post-prostatectomy PSA, a PSA > 0.5 ng/mL, or Gleason score ≥ 8, may benefit from intensification of treatment with androgen deprivation therapy or other systemic therapies at the time of ART or SRT. Utilization of genomic classifiers is increasing as they allow for improved recurrence risk estimation following prostatectomy, and they are currently used as stratification variables in clinical trials to evaluate their ability to predict response to treatment.

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Authors and Affiliations

  1. Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA

    William C. Jackson M.D. & Daniel E. Spratt M.D.

  2. Department of Urology, University of Michigan, Ann Arbor, MI, USA

    Todd M. Morgan M.D.

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  1. William C. Jackson M.D.
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Correspondence to Todd M. Morgan M.D. .

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Editors and Affiliations

  1. Department of Urologic Surgery and Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA

    Sam S. Chang

  2. Department of Urology, University of Oklahoma Medical Center, Oklahoma City, Oklahoma, USA

    Michael S. Cookson

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Jackson, W.C., Spratt, D.E., Morgan, T.M. (2018). Adjuvant Radiation Therapy for High-Risk Post-prostatectomy Patients. In: Chang, S., Cookson, M. (eds) Prostate Cancer. Springer, Cham. https://doi.org/10.1007/978-3-319-78646-9_7

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