Radical prostatectomy is the most commonly used treatment for localized prostate cancer in the United States,1 and its popularity has been growing since the introduction of robotic-assisted prostatectomy.2 Approximately one-third of men undergoing prostatectomy will have high-risk pathologic features, such as extracapsular extension, seminal vesicle invasion, or positive surgical margins.3,4 Three randomized trials have shown a benefit for treating these men with adjuvant radiation to the prostate bed, with one trial showing an overall survival advantage.5–7 Despite these data, considerable disagreement remains about the appropriate timing of postprostatectomy radiation therapy (PPRT).8 Because not all men with high-risk pathologic features will experience disease recurrence, some practitioners believe that the risk of recurrence with high-risk features is not sufficiently high to offset the potential toxicity of adjuvant treatment. An alternative strategy has been to treat at the time of biochemical recurrence, and at that point use salvage radiation therapy (RT) to the prostate bed.9
We examined our institutional database to assess how the use of PPRT has changed recently at our NCI-designated comprehensive cancer center in light of phase III data showing the efficacy of adjuvant RT. Our hypothesis is that there has been a trend toward increased use of PPRT since 2006, following the publication of initial results from EORTC 22911 and SWOG 8794 showing a benefit for adjuvant PPRT compared with observation.6,7
The authors have disclosed that they have no financial interests, arrangements, affiliations, or commercial interests with the manufacturers of any products discussed in this article or their competitors.
This publication was supported by grant number P30 CA006927 from the National Cancer Institute, NIH. In addition, this publication was supported in part by a grant from Varian Medical Systems, Inc.
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. Wiegel T Bottke D Steiner U Phase III postoperative adjuvant radiotherapy after radical prostatectomy compared with radical prostatectomy alone in pT3 prostate cancer with postoperative undetectable prostate-specific antigen: ARO 96-02/AUO AP 09/95. J Clin Oncol 2009; 27: 2924– 2930.
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