In Reply: Drs Ward and Blute point out that
patients with positive surgical margins have highly variable outcomes, and
the acute and late toxicity of postprostatectomy radiation therapy is not
trivial. In the absence of conclusive evidence demonstrating a benefit, we
do not believe that adjuvant radiotherapy is preferable to careful observation
and salvage radiotherapy at the time of documented PSA recurrence. Adjuvant
radiotherapy for patients with positive surgical margins exposes many patients
whose disease would never have recurred to the toxicity of radiation therapy.
Furthermore, given the sensitivity of modern PSA assays, which has blurred
the line between salvage and adjuvant radiation therapy, it is increasingly
uncertain whether a window of opportunity for cure is lost when high-risk
patients are observed and treated at the earliest evidence of recurrent disease.
Stephenson AJ, Slawin KM. Use and Timing of Radiotherapy in High-Risk Prostate Cancer—Reply. JAMA. 2004;291(23):2817. doi:10.1001/jama.291.23.2817-b