Paul L. Nguyen, MD

We are in urgent need of a randomized trial comparing radiation plus ADT vs ADT alone for men with node-positive prostate cancer.

The purpose of this article is to present an updated set of American College of Radiology consensus guidelines formed from an expert panel on the appropriate use of radiation therapy in postprostatectomy prostate cancer.

Under current conditions for patients with newly diagnosed node-positive prostate cancer, the benefits of surgery, if any, are highly unlikely to outweigh the known harms--less is still more.

The facts presented about screening should be tailored to the patient’s exact situation, and the patient’s values should be used to guide the final decision. For younger, healthy men, PSA screening should continue to be strongly considered.

In their article, Raldow et al provide an excellent summary of the issues surrounding the use of salvage radiotherapy for a post-prostatectomy recurrence. For practicing clinicians, the pressing issue is how to appropriately select patients for treatment with salvage radiotherapy.

In this issue of ONCOLOGY, Bittner et al provide a thoughtful review of the literature to advocate for the viewpoint that interstitial brachytherapy should be standard of care for the treatment of high-risk prostate cancer.