AUA/ASTRO 2013 Guidelines for Adjuvant and Salvage Radiation Therapy After Prostatectomy: What are the Yields and the Changes?

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Yalman D.

UROONKOLOJI BULTENI-BULLETIN OF UROONCOLOGY, vol.14, no.2, pp.144-149, 2015 (Journal Indexed in ESCI) identifier

  • Publication Type: Article / Review
  • Volume: 14 Issue: 2
  • Publication Date: 2015
  • Doi Number: 10.4274/uob.339
  • Page Numbers: pp.144-149


Adverse pathologic features such as positive surgical margins, seminal vesicle invasion and extra-prostatic extension after Radical Prostatectomy (RP) increases the recurrence risk. Administration of Radiotherapy (RT) as adjuvant therapy to the patients with adverse pathologic features before the evidence of disease recurrence (undetectable Prostatic Specific Antigen (PSA) level) or as salvage treatment after PSA recurrence without evidence of metastasis is one of the most controversial issues. In this context "American Urological Association" (AUA) and "American Society for Radiation Oncology" (ASTRO) prepared a guideline to provide direction to clinicians and patients. The guideline statements can be summarized as follows: adjuvant RT should be offered to patients with adverse pathologic features since it decreases the risk of biochemical and local recurrence and clinical progression; physicians should regularly monitor PSA to enable early administration of salvage therapies; a detectable or rising PSA value after surgery with a second confirmatory level of = 0.2 ng/mL should be defined as biochemical recurrence; a restaging evaluation may be considered in case of PSA recurrence; salvage RT should be offered to patients with PSA or local recurrence in whom there is no evidence of distant metastasis; the effectiveness of salvage RT is greatest when given at lower levels of PSA; patients should be informed of the possible short-term and long-term morbidity of RT. Although this guideline has not resolved the controversy regarding adjuvant or salvage RT it is an important step that two important societies-AUA and ASTRO-gathered together for the first time and prepared a guideline. It is expected that the results of ongoing randomized studies will bring clarification to this issue. No matter how controversial the issue is, the most important point is that the decision to administer adjuvant or salvage RT should be made by the patient and the multidisciplinary team together, and it must be kept in mind that every patient has different characteristics and the benefit/risk ratio will be different for each patient.