ASCO has issued an endorsement of the American Urological Association (AUA)/American Society for Radiation Oncology (ASTRO) guideline on the use of adjuvant and salvage radiotherapy after prostatectomy, which was based on a systematic review of medical literature. The ASCO endorsement was published recently in the Journal of Clinical Oncology1 and will be reviewed in detail in an upcoming issue of The ASCO Post.
The AUA/ASTRO guideline recommends that physicians discuss adjuvant radiotherapy with patients who have adverse pathologic findings at prostatectomy (ie, seminal vesicle invasion, extensive positive surgical margins) and salvage radiotherapy with patients with detectable postoperative prostate-specific antigen (PSA) or local recurrence after prostatectomy.
Patients should be informed that, while adjuvant radiotherapy reduces the risk of recurrence and disease progression, its impact on preventing metastases and extending survival is less clear.
An ASCO guideline endorsement panel determined that the guideline recommendations, published in August 2013 in the Journal of Urology,2 are clear, thorough, and based on the most relevant scientific evidence.
The Society added one qualifying statement that not all men who are candidates for adjuvant or salvage radiotherapy have the same risk of recurrence or disease progression, and thus, not all men will derive the same benefit from adjuvant radiotherapy. Those at the highest risk for recurrence after radical prostatectomy (including men with seminal vesicle invasion, Gleason score 8 to 10, extensive positive margins, and detectable postoperative PSA) are likely to derive the greatest benefit.
The guideline is available at http://www.asco.org/guidelines/genitourinary-cancer, along with supplementary materials. ■
1. Freedland SJ, Rumble RB, Finelli A, et al: Adjuvant and salvage radiotherapy after prostatectomy: ASCO Clinical Practice Guideline Endorsement. J Clin Oncol. November 3, 2014 (early release online).
2. Thompson IM, Valicenti RK, Albertsen P, et al: Adjuvant and salvage radiotherapy after prostatectomy: AUA/ASTRO Guideline. J Urol 190:441-449, 2013.