Purpose of review 

During decades, adjuvant radiotherapy (ART) has been the standard of care after surgery, based on four randomized clinical trials (RCTs). As early salvage radiotherapy (SRT) recently challenged the ART paradigm, the optimal timing to initiate radiotherapy remains a matter of debate.

Recent findings 

Three RCTs evaluated ART or SRT for postprostatectomy patients, with pathological risk factors (Gleason score > 8, pT3, positive margins). The ARTISTIC meta-analysis demonstrated similar 5-year biochemical recurrence-free survival for ART and SRT (89 vs. 88%). Lower rates of late genitourinary toxicity were demonstrated within the SRT arm, favouring early SRT in clinical practice.

The addition of pelvic lymph node radiotherapy recently demonstrated an improvement in freedom from progression within the randomized RTOG 0534 trial, especially for patients with pretreatment prostate serum antigen (PSA) levels more than 0.35 ng/ml. The most appropriate androgen deprivation therapy duration remains a point of controversy.

Summary 

The SRT approach can be favoured for the vast majority of patients, provided close monitoring of PSA and early treatment in the event of biochemical recurrence. Radiotherapy dose and volumes and ADT use might be correlated to SRT timing (early vs. late). Results from trials including genomic tests and metabolic imaging will probably help to refine these criteria.

中文翻译：

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根治性前列腺切除术后的放射治疗：谁、何时以及为什么？

审查目的 

几十年来，基于四项随机临床试验 (RCT)，辅助放疗 (ART) 一直是手术后的标准治疗。由于早期挽救放疗(SRT) 最近挑战了 ART 模式，因此开始放疗的最佳时机仍然存在争议。

最近的发现 

三项 RCT 评估了前列腺切除术后患者的 ART 或 SRT，具有病理危险因素（格里森评分 > 8，pT3，阳性切缘）。ARTISTIC 荟萃分析表明 ART 和 SRT 的 5 年生化无复发生存率相似（89% 对 88%）。SRT 组的晚期泌尿生殖系统毒性发生率较低，有利于临床实践中的早期 SRT。

最近，在随机 RTOG 0534 试验中，加入盆腔淋巴结放疗证明可以改善疾病进展，尤其是对于治疗前前列腺血清抗原 (PSA) 水平超过 0.35 ng/ml 的患者。最合适的雄激素剥夺治疗持续时间仍然是一个争议点。

概括 

SRT 方法可能对绝大多数患者有利，它提供了对 PSA 的密切监测和生化复发事件的早期治疗。放疗剂量和体积以及 ADT 使用可能与 SRT 时间（早期与晚期）相关。包括基因组测试和代谢成像在内的试验结果可能有助于完善这些标准。