A 68-year-old man with high-risk prostate cancer (PSA 22, Gleason 4+5=9, clinical stage T3a) undergoes radical prostatectomy. Pathology reveals extracapsular extension and positive surgical margins. Which postoperative intervention has the highest level of evidence for reducing biochemical recurrence in this setting?
- A Androgen deprivation therapy (ADT) alone
- B Salvage radiotherapy when PSA rises to >0.2 ng/mL
- C Immediate adjuvant radiotherapy to the prostate bed ✓
- D Docetaxel chemotherapy adjuvant to surgery
Correct answer: C. Immediate adjuvant radiotherapy to the prostate bed
Explanation
Three randomised trials (SWOG 8794, ARO 96-02, EORTC 22911) demonstrated that immediate adjuvant radiotherapy to the prostate bed after radical prostatectomy with adverse features (positive margins, extracapsular extension, seminal vesicle invasion) significantly reduces biochemical recurrence and metastasis-free survival compared to observation. RADICALS-RT showed equivalence between adjuvant and early salvage RT, but adjuvant RT has the highest level 1 evidence for high-risk pathological features. ADT alone is insufficient.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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