A 68-year-old man is diagnosed with high-risk prostate cancer (Gleason 4+4=8, cT3a, PSA 22 ng/mL). He undergoes radical prostatectomy and final pathology shows pT3bN1 disease. According to RADICALS-HD and GETUG-AFU 22 trial data, what adjuvant treatment offers the best oncological outcomes?
- A Salvage radiotherapy when PSA rises to 0.1–0.2 ng/mL with long-term ADT ✓
- B Immediate adjuvant radiotherapy to prostate bed regardless of PSA
- C Immediate androgen deprivation therapy (ADT) alone for 2 years
- D Observation until PSA >1.0 ng/mL before any intervention
Explanation
RADICALS-HD, GETUG-AFU 22, and RAVES trials collectively support early salvage radiotherapy (at PSA rise to 0.1–0.2 ng/mL, before PSA >0.5 ng/mL) combined with long-term ADT as equivalent to immediate adjuvant radiotherapy but with less genitourinary toxicity when PSA is undetectable post-surgery. The RADICALS-RT protocol favors PSA-triggered salvage RT plus 24 months ADT. Immediate adjuvant RT causes unnecessary toxicity when PSA is undetectable. ADT monotherapy alone without RT is inferior for pN1 disease. Waiting until PSA >1.0 ng/mL delays effective therapy and worsens metastasis-free survival.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.