Expert Point of View: Anthony D’Amico, MD

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Now there are mature data from three trials comparing adjuvant radiotherapy vs a wait-and see approach in men following radical prostatectomy, said formal discussant Anthony D’Amico, MD, Dana-Farber Cancer Center and Harvard Medical School, Boston, at the Genitourinary Cancers Symposium.

Despite the variations in patient population in these trials, all three showed a clear benefit for adjuvant radiotherapy in biochemical recurrence. However, these trials had different findings for other clinical endpoints.

Dr. D’Amico believes that the differences in clinical outcomes among these trials may be accounted for by different methods of ascertaining failure and differences in the timing of initiating salvage therapy in the watchful waiting arm.

“It is possible that early salvage therapy with PSA < 0.1 ng/mL may produce the same results as adjuvant radiotherapy. We await the results of two randomized trials—RADICALS and RAVES—to answer this question,” he stated.

Until the results of these ongoing trials are available, Dr. D’Amico said that to reduce overtreatment, the decision to initiate adjuvant radiotherapy should be based on the number of risk factors for recurrence, including Gleason score, surgical margin status, and extension into the seminal vesicles or through the capsule. ■

Disclosure: Dr. D’Amico reported no potential conflicts of interest.

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