Comparing Adjuvant vs Early-Salvage Radiotherapy After Radical Prostatectomy

To the Editor Optimum management for men with adverse pathologic features (ie, pT3 and/or positive margins) at radical prostatectomy remains a topic of ongoing research. Specifically, should these patients receive immediate adjuvant radiotherapy (ART), or is it better to observe until a change in prostate-specific antigen (PSA) level suggests disease progression? The work by Hwang et al adds a valuable perspective to this debate. The authors compared men who received immediate ART with an undetectable PSA vs early-salvage radiotherapy (ESRT), once the PSA reaches 0.1 to 0.5 ng/mL (to convert to micrograms per liter, multiply by 1.0). They found that ART was associated with lower risks of biochemical recurrence, distant metastases, and death for these high-risk patients.

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