A 68-year-old man with prostate cancer (Gleason 4+3=7, PSA 12 ng/mL, cT2b) undergoes radical prostatectomy. Final pathology shows positive surgical margins and extraprostatic extension (pT3a). According to current EAU guidelines for adjuvant therapy after radical prostatectomy with pT3a disease:
- A Observation with PSA monitoring; salvage radiotherapy reserved for PSA rise >0.1 ng/mL ✓
- B Adjuvant androgen deprivation therapy (ADT) alone is standard of care
- C Adjuvant radiotherapy to the prostate bed is recommended immediately
- D Adjuvant docetaxel-based chemotherapy is standard
Correct answer: A. Observation with PSA monitoring; salvage radiotherapy reserved for PSA rise >0.1 ng/mL
Explanation
Three landmark RCTs (RADICALS, RAVES, GETUG-AFU 17) and subsequent meta-analysis (ARTISTIC) demonstrated that immediate adjuvant radiotherapy is not superior to early salvage radiotherapy triggered by PSA rise in patients with pT3 disease after radical prostatectomy. EAU guidelines now recommend observation with PSA monitoring and early salvage radiotherapy initiated when PSA rises to 0.1–0.2 ng/mL (before reaching 0.5 ng/mL). Adjuvant ADT alone is insufficient for local recurrence. This represents a major paradigm shift from earlier recommendations.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.