Are All Prostate Cancer Patients "Fit" for Salvage Radiotherapy?

The publication of this article reflects the need to optimize the treatment and appropriately select the patients receiving postoperative radiotherapy in prostate cancer. With the preliminary data reported by RADICALS, RAVES and ARTISTIC studies, early salvage EBRT has acquired relevance against the established evidence from Phase III trials of adjuvant radiotherapy. This novel data together with the growing number of high-risk prostate cancer undergoing radical prostatectomy has provoked a marked increase in the number of patients receiving postoperative treatment in radiation oncology departments.

The authors of the article want to warn about the desirability of a better selection of patients who have a biochemical recurrence and who can benefit from salvage radiotherapy and, especially, to raise the need for the use of advanced imaging techniques. Novel diagnostic techniques such as multiparametric MRI or PET/CT, allow us to better identify patients who may benefit from local treatments and may also help us to tailor treatment. We must not continue treating all patients blindly.

The proposed algorithm in our manuscript (Figure 1), is simple and feasible; is a tool to optimize patient selection and to better treat them, supported by stratification of patients in risk groups (Table 1). We encourage radiation oncologist colleagues to incorporate it into their clinical practice and exchange experiences and results.

Fig. 1 Algorithm of biochemical recurrence

*Chemotherapy addition according to multidisciplinary board decision.
** SRT if patients assume the risks.

Table 1. Treatment recommendation based on three risk groups
table 1 Treatment recommendation based on three risk groups

table 1 Treatment recommendation based on three risk groups

Written by: Carmen González-San Segundo, MD, Department of Radiation Oncology, HGU Gregorio Marañon, Complutense University, Madrid, Spain; Alfonso Gómez-Iturriaga, MD, Biocruces Health Research Institute, Cruces University Hospital, Barakaldo, Spain; Felipe Couñago, MD, Department of Radiation Oncology, Hospital Universitario Quirónsalud Madrid, Madrid, Spain.

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