Two different perspectives in the management of pT3 and/or margin-positive prostate cancer after radical prostatectomy

Debate on the optimum management of pT3 and/or positive resection margins with undetectable PSA after radical prostatectomy (RP) has continued in recent years. Many clinicians think that the question remains unanswered despite the recent Phase III study results showing a better PSA-relapse-free survival with adjuvant radiotherapy (RT) after RP. The oncology community is divided into two opposite views as a result of the following important and unresolved question. Should a blanket policy of adjuvant RT be applied to all patients with pT3 and/or a positive resection margin? Or can a strategy of surveillance with timely implementation of salvage RT limited to only those with PSA relapse be equally effective? In this review we aim to address two different perspectives in the management of patients with pT3 and/or positive resection margins with undetectable PSA levels after RP. It also calls for a Phase III study to properly answer the above question.