- A high percentage of radical prostatectomy (RP) patients with high-risk pathologic features (positive surgical margins, extraprostatic extension of cancer, seminal vesicle involvement) will experience a subsequent biochemical failure, often due to progression of residual disease within the surgical bed.
- The addition of adjuvant RT <br />directed at the prostatic fossa in these patients has been shown in three prospective randomized trials to improve the biochemical freedom-from-failure rate in the irradiated patients and, in one trial, provided improvement in metastasis-free and overall survival.
- Salvage RT, in which patients with biochemically detectable disease receive RT to the prostate bed, has been associated with improvements in cancer-specific and overall survival in retrospective series but has not been tested in a randomized fashion.
- The appropriate radiation dose to the prostatic fossa in the adjuvant or salvage setting ranges from 64.8 Gy to 70.2 Gy. Higher doses may be appropriate if there is evidence of gross recurrence within the prostate bed.
- Addition of pelvic RT to prostatic fossa radiation is generally discouraged, but it may be appropriate in certain clinical situations (eg, absence of lymph node dissection, evidence of nodal involvement at prostatectomy or on imaging studies).
- The benefit of neoadjuvant/adjuvant androgen deprivation therapy with adjuvant or salvage radiation is the subject of ongoing clinical trials.