Salvage radiotherapy for PSA failure after radical prostatectomy

Background and purpose: Prostate-specific antigen (PSA) failure after radic al prostatectomy is a common clinical scenario, and there is no consensus o n how it should be managed. Salvage radiation to the prostatic bed is a pot entially curative treatment option, and is the subject of this review. Pati ent selection, and the efficacy and toxicity of treatment will be discussed , and recommendations made for current practice and future studies. Methods: An English language MEDLINE search was performed, limited to the y ears 1989-2000, using the MeSH headings 'prostatic neoplasms' and 'radiothe rapy'. The 660 abstracts identified were reviewed, and articles concerning patient selection for, or outcome of, postoperative radiation to the prosta tic bed selected. After exclusion of articles concerning adjuvant, rather t han salvage, radiation, this left a total of 22 case series, including 1062 patients for the review of treatment efficacy. Results and conclusions: The quality of the evidence makes it difficult to form a judgment regarding the efficacy of salvage radiation following radic al prostatectomy, particularly in men with a PSA level in the range 0.01-0. 2 ng/ml. Salvage radiation may be more effective,given earlier rather than later. These considerations have important consequences for the interpretat ion of current trials of adjuvant radiation following radical prostatectomy . (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.