Radiotherapy after radical prostatectomy for patients with increased PSA without histologically confirmed local recurrence - A curative treatment option?

Within 5 years following radical prostatectomy, 15-60% of patients with pT3 prostate carcinoma show increasing or persistently raised PSA values, a si gn of local and/or systemic tumor progression. Percutaneous, 3-dimensionall y planned local irradiation with a total dose of 60-70 Gy can reduce PSA to the undetectable range again in 30-70%. Of these patients, 40-65% remain w ithin the undetectable level for 2-5 years after radiotherapy. PSA levels s hould be as low as possible (<2 ng/ml) when starting radiotherapy. With hig her PSA levels, the chance of achieving an undetectable PSA level again dec reases to less than 35% of the patients. Severe late side effects of 3-D pl anned radiotherapy are infrequent (<3%). Primary hormonal treat-ment in pat ients with increased PSA is longterm and only palliative in nature, with a median time to the development of metastases of 4-7 years. This hormonal tr eatment can also be given after failure of radiotherapy. Taking into consid eration that the follow-up periods for patients treated with radiotherapy f or increased PSA after radical prostatectomy are too short for final conclu sions, it nevertheless appears that radiotherapy may be the only measure wi th curative potential in selected patients.