Radiotherapy After Prostatectomy: Updated Joint Clinical Guidance by ASTRO and AUA
Posted: Monday, July 1, 2019
According to amendments added to the guideline from the American Society for Radiation Oncology (ASTRO) and the American Urological Association (AUA) and published in Practical Radiation Oncology, hormone therapy should be offered to patients with prostate cancer who have had radical prostatectomy and who are candidates for salvage radiotherapy. The recommendation is one of several updates to the joint clinical guideline on adjuvant and salvage radiotherapies after prostatectomy in patients with and without evidence of prostate cancer recurrence, noted Thomas M. Pisansky, MD, of the Mayo Clinic, Rochester, Minnesota, and colleagues.
“We now know that radiotherapy and the combination of hormone therapy with radiation, following radical prostatectomy, have contributed to even more favorable outcomes for patients than seen previously,” said Co-Chair of the Guideline Panel, Richard K. Valicenti, MD, FASTRO, of the University of California, Davis, Comprehensive Cancer Center, in an ASTRO press release. “With the current update, this collaborative guideline now reflects nearly 3 decades of multidisciplinary research.”
The original systemic review from ASTRO and the AUA focused on 294 studies published between 1990 and 2012. The latest guideline incorporated 155 references published from 1990 to 2017 and resulted in the addition of two new key questions for practitioners—one on the use of genomic classifiers and the other on the treatment of oligometastases with radiation after radical prostatectomy.
The panel members used long-term data from three randomized control trials—including the ARO 96-02 trial—to update an existing statement on adjuvant radiotherapy. They recommend that clinicians inform patients who have adverse pathologic findings that adjuvant radiotherapy, compared with radical prostatectomy alone, reduces the risk of biochemical recurrence, local recurrence, and clinical progression of cancer. Regarding hormone therapy, the decision to use the treatment should be made by patients and a multidisciplinary team of providers.
Disclosure: The study authors’ disclosure information may be found at practicalradonc.org.