Postoperative radiotherapy after radical prostatectomy in patients with prostate cancer
Article published in Urologia Polska 2003/56/4.

authors

Piotr Milecki ¹, Zbigniew Kwias ², Janusz Skowronek ¹, Tomasz Stachowski ²

¹ Wielkopolskie Centrum Onkologii w Poznaniu
Dyrektor centrum: dr hab. Julian Malicki
² Katedra Urologii Akademii Medycznej w Poznaniu
Kierownik katedry: prof. dr hab. Zbigniew Kwias

keywords

prostate, radical prostatectomy, adjuvant radiotherapy, salvage radiotherapy

summary

Radical prostatectomy (RP) is currently the standard method of treatment for prostate cancer. One of the most essential problems after RP is the postoperative positive margin occurring in some patients. Therefore, the usefulness of postoperative radiotherapy is being considered in these cases more frequently. Moreover, the regional recurrences after the surgical treatment cause the effectiveness of the salvage radiotherapy to be reconsidered. The currently available data evaluating the effectiveness of radiotherapy after radical prostatectomy are based on retrospective studies because of the lack of results of the prospective randomized studies which are still in progress. Radiation treatment after the RP can have the nature of a typical postoperative radiotherapy used directly after radical prostatectomy in patients with the following factors risk of failure: the presence of pathologic T3 (pT3), positive surgical margin, Gleanson score >6 but in case of the presence of biochemical recurrence was not affirmed with routine diagnostic methods. The outcome of retrospective analyses shows that postoperative radiotherapy is highly effective. However, there is still a lack of reliable data indicating how the improvement of local control, which results from the implementation of postoperative radiotherapy, influences the overall survival of patients.

Another postoperative radiation strategy is salvage radiotherapy which is introduced in the case of disease recurrences in the postoperative bed. The efficacy of the salvage radiotherapy is lower than the classical adjuvant radiotherapy.

Still, the following issues remain problematic and unsolved: the beginning of radiotherapy (direct vs. postponed radiotherapy), the optimal dose (low vs. high), the irradiated area, adjuvant hormonal therapy (radiotherapy vs. radiotherapy plus hormonal therapy). Hormonal therapy is also the subject of a randomized clinical trial and the initial results show the possibility of gaining profits in the case of the application of the combined treatment.

In summary, postoperative radiotherapy after radical prostatectomy is a method of treatment, which should be taken into account in patients with the high risk of disease recurrences after surgery or in patients with the recurrence of the disease in the tumour bed.