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June 11, 2020

Adjuvant vs Salvage Radiation Therapy for High-Risk Prostate Cancer Following Radical Prostatectomy

Author Affiliations
  • 1Brown University Warren Alpert Medical School, Providence, Rhode Island
  • 2Brigham and Women’s Hospital and Dana Farber Cancer Institute Boston, Massachusetts
JAMA Oncol. Published online June 11, 2020. doi:10.1001/jamaoncol.2020.0565

The use of adjuvant radiation therapy (RT) vs surveillance following radical prostatectomy in men who have prostate cancer with evidence of disease extension beyond the prostate gland or at the surgical margin has been shown, in 3 randomized studies,1 to halve the risk of progression. However, these randomized studies were performed at a time when prostate-specific antigen (PSA) was not used routinely during postoperative follow-up to monitor and trigger salvage RT if the PSA level became measurable, as we do today. Therefore, 2 randomized studies2,3 were designed to determine whether the delivery of prostatic bed RT in the adjuvant setting (ie, undetectable PSA) vs salvage setting (ie, detectable PSA) was superior, with a primary end point of progression-free survival (PFS) in the Triptorelin and Radiation Therapy in Treating Patients Who Have Undergone Surgery for Intermediate-Risk Stage III or Stage IV Prostate Cancer (GETUG-AFU 17) study3 and metastasis-free survival (MFS) in the Radiation Therapy and Androgen Deprivation Therapy in Treating Patients Who Have Undergone Surgery for Prostate Cancer (RADICALS) study.2 The Radiotherapy–Adjuvant Vs Early Salvage (RAVES) study4 was designed to assess whether PFS with salvage RT was noninferior to adjuvant prostatic bed RT. These 3 studies have been analyzed using a meta-analysis5 where the superiority of salvage vs adjuvant RT was explored.

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