Adjuvant vs. salvage radiotherapy for pathologically advanced prostate cancer

Purpose of review This article considers the efficacy and toxicity of postoperative radiotherapy to the prostate bed after radical prostatectomy. It has a particular focus on the debate concerning the optimum timing of postoperative radiotherapy: adjuvant treatment for all high-risk cases vs. salvage treatment at the time of prostate-specific antigen relapse. Recent findings Postoperative radiotherapy has been shown, in a mature randomized trial, to improve overall survival after radical prostatectomy. Randomized trials have also provided good data on the morbidity of postoperative radiotherapy. Summary Postoperative radiotherapy improves survival in patients with high-risk pathological features at radical prostatectomy at the cost of moderate urinary and bowel toxicity. The optimum timing of postoperative radiotherapy, and in particular the relative merits of adjuvant vs. salvage radiotherapy, remains uncertain.