12 Postoperative RT in PCa

Question 1

Adjuvant treatment for pN0 and pN1 after radical prostatectomy : EAU 2023

Answer 1

Question 2

At which maximal PSA are local recurrences best treated by salvage RT?

Answer 2

Local recurrences are best treated by salvage RT with 64-66 Gy at PSA serum < 0.5ng/ml, as there is a chance of second cure (EAU) and the success is 2/3.

Question 3

At which maximal PSA are local recurrences best treated by salvage RT?

Answer 3

Question 4

Data about adjuvant Radiotherapy after prostatectomy

Answer 4

Question 5

Timing of postoperative RT in PCa

Answer 5

Question 6

Early salvage in PCa – can we generalize it to all patients? ARTISTIC Meta-analysis

Answer 6

Studies did NOT show superiority of adjuvant RT over salvage RT on event free survival (FU 60-78 mo). However, this cannot be generalized to all pts.

Question 7

Adjuvant versus salvage bei operierten PCa?

Answer 7

Bei hochrisiko Patienten ist adjuvante RT Standard, bei allen anderen Salvage-RT ist Standard.

Question 8

Adjuvante und Salvage Bestrahlung bei operierten PCa- S3 LL Stand 2021

Answer 8

Question 9

Adjuvante RT bei pN0

Answer 9

Question 10

Role of ADT in the setting of salvage RT to prostate bed

Answer 10

Question 11

Which conclusions can one take from the Shipley (RTOG 9601) and Carrie trial (GETUG-AFU 16)?

Answer 11

Consider ADT if PSA > 0.6 OR
**Combination of very high risk features (pT3b, R1, pN1, Gleason 8-10)

**not so clear

Question 12

Role of ADT + PLNRT (pelvic LN irradiation) in the setting of salvage RT to prostate bed : RTOG 0534 SPPORT trial

Answer 12

Pollack et al. Lancet 2022

Question 13

Which patients should receive androgen deprivation therapy combined with Salvage radiotherapy? EAU 2023

Answer 13

It is not evident which patients should receive ADT, which type of ADT, and for how long.
High risk of further progression (e.g., with a PSA > 0.7 ng/mL and GS > 8) may benefit from RT combined with 2 years of ADT;

Lower risk (e.g., PSA < 0.7 ng/mL and GS = 8) RT combined with 6 months of ADT may be sufficient.

Low-risk profile (PSA < 0.5 ng/mL and GS < 8) may receive RT alone.

Question 14

Is there any optimal RT dose to prostate bed?

Answer 14

It should be at least 64 Gy to the prostatic fossa (+/- the baseof the SVs, depending on the pathological stage after RP).

Question 15

Which Randomized trials investigated dose escalation for Salvate RT without ADT and without PET-CT?

Answer 15

SAKK 09/10 trial : n=250, pT2-3b, R0-R1, PSA 0.1-0.4 ng/ml; 64 vs 70 Gy
Phase-III-Trial : n=144; pT2-4; R0-R1; PSA 0.2 ng/ml; 66 vs 72 Gy

No patient had a PSMA PET/CT before randomisation. The primary endpoint in both trials was ‘freedom from biochemical progression’, which was not significantly improved with higher doses. However, in the Chinese trial a subgroup analysis showed a significant improvement of this endpoint for pts with Gleason 8-10 tumours (79.7% vs. 55%, p = 0.049). However, the Chinese trial was small. At this time it seems difficult to draw final conclusions about the optimal total RT-dose and longer follow-up should be awaited.