Early salvage versus adjuvant therapy for treatment of prostate cancer following prostatectomy

The prospective adaptive meta-analysis by the ARTISTIC collaboration did not demonstrate that adjuvant radiotherapy following radical prostatectomy improves event-free survival over early salvage radiotherapy. Early salvage is preferred over adjuvant therapy to reduce overtreatment and associated side effects. In patients with localised prostate cancer, the goal of radical prostatectomy is to remove the entire primary tumour. This goal is reached in some patients, but in others, cancerous tissue may be left behind. To protect against local recurrence in high-risk patients, the prostate bed is commonly irradiated after radical prostatectomy. However, the optimal timing of radiotherapy—whether immediately postprostatectomy (adjuvant) or after early biochemical evidence of recurrence (early salvage)—has been the subject of ongoing debate. Recent guidelines1 2 recommend that adjuvant radiotherapy be offered to patients with adverse pathological findings at prostatectomy, although adjuvant radiotherapy is uncommonly used in practice.3 Randomised trials conducted between 1988...
Source: Evidence-Based Medicine - Category: Internal Medicine Authors: Tags: EBM Verdict Source Type: research