ASTRO/AUA Guideline on Adjuvant and Salvage Radiation Therapy After Prostatectomy

Published Update: April 2019

Read Executive Summary (2018 update)
Read Full-Text Guideline (2013 and 2018 update)

The 2013 full-text collaborative guideline developed recommendations on several questions related to appropriate use of radiation therapy (RT) in patients who have undergone prostatectomy, both as adjuvant therapy following surgery and after recurrence. It examines the impact of adjuvant RT on recurrence and survival and how these outcomes are affected by factors such as margin status, seminal vesicle invasion, Gleason score and patient age. For salvage therapy, the guideline also addresses whether RT improves outcomes and whether its effects are limited to certain patient subgroups. In addition, the document considers the question of whether to administer adjuvant RT prior to recurrence or wait and treat patients who recur with salvage RT. Finally, RT techniques, use of androgen deprivation therapy together with RT, and data on toxicity and quality of life in the post-prostatectomy setting are discussed. The 2018 update incorporates new data related to these questions and added questions on use of genomic classifiers and treatment of oligo-metastases with RT post-radical prostatectomy.

Developed in collaboration with:

• American Society for Radiation Oncology
• American Urological Association 

Endorsed by:

American Society of Clinical Oncology

Key Points:

• Counseling patients concerning risks of cancer recurrence after radical prostatectomy and benefits and risks of adjuvant radiotherapy (ART)
• Offering patients ART after prostatectomy
• Monitoring prostatic specific antigen (PSA) levels after prostatectomy to detect recurrence
• Restaging evaluation in patients with a PSA recurrence
• Offering salvage radiotherapy (SRT) to patients with PSA or local recurrence
• Informing patients about effectiveness of radiotherapy for PSA recurrence
• Informing patients about benefits and short- and long-term side effects of SRT for controlling disease recurrence

Resources:
News Release - April 30, 2019
Challenging Cases in the Management of Newly Diagnosed and Recurrent Prostate Cancer (CME)