Radiation therapy after prostatectomy: now or later?

Patients with pathological stage T3 or T4 prostate cancers who have undetectable prostate-specific antigen (PSA) levels after radical retropubic prostatectomy (RRP) have a substantial risk of recurrence. The first sign of recurrence is a rising PSA level, which precedes clinical evidence of failure by months to years. Adjuvant radiation therapy can significantly reduce the risk of failure in these patients. Patients with rising PSA levels after RRP can be salvaged with radiation therapy. Larger series report that between 30% and 54% of carefully staged patients can be salvaged with radiation therapy alone. It is possible that more patients may be salvaged in the future with the use of combined radiation therapy and hormonal therapy. Although one cannot be certain which approach-adjuvant or salvage radiation therapy- is better, studies are being performed that will help clarify this clinical dilemma. Copyright 1998 W.B. Saunders Company.