Individualization of Adjuvant Therapy After Radical Prostatectomy for Clinically Localized Prostate Cancer: Current Status and Future Directions.
Radiation therapy indications in the postprostatectomy setting are evolving. Several retrospective series have identified a number of "high-risk" pathologic features associated with an elevated risk of disease recurrence after radical prostatectomy. More recently, several randomized phase III trials demonstrated superior biochemical relapse-free survival for adjuvant radiation therapy after prostatectomy for patients with these high-risk pathologic features, including positive margin status, extraprostatic extension, and/or seminal vesicle invasion. These series further suggested improvement in distant metastasis control and overall survival after 15 years. However, not all patients with high-risk features experience disease recurrence after surgery alone, and some subsets of patients experience suboptimal disease control and survival despite immediate postoperative radiotherapy. Furthermore, some patients without high-risk features will develop recurrence. The present review discusses the current data and potential future directions to improve individualization of therapy after prostatectomy.
Department of Radiation Oncology, University of Iowa Carver School of Medicine, Iowa City, IA.
Darrion L
DL
Mitchell
Department of Urology, University of Iowa Carver School of Medicine, Iowa City, IA.
Chad R
CR
Tracy
Department of Radiation Oncology, University of Iowa Carver School of Medicine, Iowa City, IA.
John M
JM
Buatti
Department of Radiation Oncology, University of Iowa Carver School of Medicine, Iowa City, IA.
Mark C
MC
Smith
Department of Pathology, University of Iowa Carver School of Medicine, Iowa City, IA.
Anthony N
AN
Snow
Department of Molecular Physiology and Biophysics and Holden Comprehensive Cancer Center, University of Iowa Carver School of Medicine, Iowa City, IA.
Michael D
MD
Henry
Department of Hematology and Oncology, University of Iowa Carver School of Medicine, Iowa City, IA.
Daniel A
DA
Vaena
Iowa City Cancer Treatment Center, Iowa City, IA.
Hamed H
HH
Tewfik
Department of Radiation Oncology, University of Iowa Carver School of Medicine, Iowa City, IA. Electronic address: john.m.watkins.md@hotmail.com.
John M
JM
Watkins
D000970:Antineoplastic Agents / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D006801:Humans; D008297:Male; D057285:Precision Medicine; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000628:therapy*; D018714:Radiotherapy, Adjuvant
D000970:Antineoplastic Agents
Adjuvant therapy; Margin involvement; Prostate neoplasms; Radiotherapy; Surgical pathology