Defining the Role of Postoperative Radio-Hormone Therapy in Prostate Cancer.

Abstract

Purpose of review: Postoperative radio-hormone therapy plays a significant role in management of prostate cancer after radical prostatectomy (RP), particularly in efforts to reduce biochemical recurrence (BCR), distant metastasis, and improve overall survival. BCR rates can be upwards of 50-70% at 5 years, highlighting the need for optimized risk stratification and consideration of multimodal treatment approaches. The purpose of this review is to highlight evidence-based treatment recommendations, and call attention to the importance of personalized therapeutic strategies after RP.

Recent findings: Both radiotherapy (RT) and ADT have been shown to optimize survival outcomes and to reduce disease progression in patients with persistent PSA, pathologic lymph-node positive disease, and adverse pathology. Early salvage RT (SRT) is typically a preferred treatment approach as it allows for treatment intensification only when clinically indicated, avoiding unnecessary radiation in men who may never recur. ADT is often added to external beam radiation therapy (EBRT) to enhance treatment efficacy, particularly in patients with high-risk features, though in selected lower-risk scenarios, radiation alone may be sufficient. Short-term ADT is appropriate for low-intermediate risk patients and long-term is appropriate for patients with advanced pathological features or nodal involvement. For certain high-risk pathologic findings, such as positive surgical margins and seminal vesicle invasion (T3b), adjuvant RT (aRT) may be indicated to optimize disease control. Overall, radio-hormone therapy plays a significant role in the postoperative setting by reducing the risk of recurrence and disease progression, and improving survival outcomes. There are several well-validated tools that may offer personalized risk assessments to identify which patients may most benefit from adjuvant or salvage therapies. Finally, the optimal use of such therapies continues to be investigated with ongoing trials.