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Prostate Cancer
Volume 2012 (2012), Article ID 963417, 8 pages
http://dx.doi.org/10.1155/2012/963417
Review Article

Postoperative Radiotherapy after Radical Prostatectomy: Indications and Open Questions

1Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland
2Department of Radiation Oncology, Kantonsspital Graubünden, 7000 Chur, Switzerland
3Department of Radiation Oncology, University Hospital Basel, 4031 Basel, Switzerland

Received 15 July 2011; Revised 14 December 2011; Accepted 15 December 2011

Academic Editor: Jay P. Ciezki

Copyright © 2012 Pirus Ghadjar et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Biochemical relapse after radical prostatectomy occurs in approximately 15–40% of patients within 5 years. Postoperative radiotherapy is the only curative treatment for these patients. After radical prostatectomy, two different strategies can be offered, adjuvant or salvage radiotherapy. Adjuvant radiotherapy is defined as treatment given directly after surgery in the presence of risk factors (R1 resection, pT3) before biochemical relapse occurs. It consists of 60–64 Gy and was shown to increase biochemical relapse-free survival in three randomized controlled trials and to increase overall survival after a median followup of 12.7 years in one of these trials. Salvage radiotherapy, on the other hand, is given upon biochemical relapse and is the preferred option, by many centers as it does not include patients who might be cured by surgery alone. As described in only retrospective studies the dose for salvage radiotherapy ranges from 64 to 72 Gy and is usually dependent on the absence or presence of macroscopic recurrence. Randomized trials are currently investigating the role of adjuvant and salvage radiotherapy. Patients with biochemical relapse after prostatectomy should at the earliest sign of relapse be referred to salvage radiotherapy and should preferably be treated within a clinical trial.