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June 16, 2004

Use and Timing of Radiotherapy in High-Risk Prostate Cancer—Reply

JAMA. 2004;291(23):2817. doi:10.1001/jama.291.23.2817-b

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.

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