PMID: 7526515Nov 1, 1994Paper

Radiation therapy for local recurrence of prostate cancer after radical prostatectomy

The Urologic Clinics of North America
T K Takayama, P H Lange

Abstract

A definitive conclusion about the value of ART is not possible from the data available: Both the methods of radiation therapy and the techniques in the diagnosis of locally persistent disease have evolved over the years. Currently, the data lead to the conclusion that ART decreases local recurrence but does not improve overall survival. Yet the PSA data strongly suggest that only locally persistent disease is a common event after radical prostatectomy (particularly in margin-positive disease only) and that current ART techniques are inadequate in many but not all of these patients. Certainly some men seem to have their local disease eliminated by ART to remain NED, but it is unclear exactly how to select them. Many experts also believe that keeping the PSA as low as possible for as long as possible, with sequential applications of ART and then androgen ablation as necessary, is a good emotional if not medical strategy. For example, all patients now wish to know their PSA level and worry about it. Also, potency can be maintained or regained after ART but becomes improbable after androgen ablation because of loss of libido. Clearly, a study randomizing high-risk postoperative patients into observation versus ART is needed and ind...Continue Reading

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