In patients who have undergone radical prostatectomy and found to have positive margins microscopically in the resection specimen, there are now good data to support the routine use of post-operative radiotherapy.
A trial (SWOG 8794), the results of which were presented at the 47th annual meeting of the American Society of Therapeutic Radiology involved 425 men all of whom had positive margins at surgery and with a median follow up of ten years. The trial demonstrated that the biochemical (i.e PSA) relapse free data were significantly better in the radiotherapy group (versus no post-operative therapy). Thus at five years from therapy, the relapse free data were 84% versus 6% and at 10 years they were 68% versus 49%.
Overall survival was not significantly different but there were low numbers at the ten year follow-up point. Adjuvant post-operative therapy is recommended in all patients who are found to have positive margins in their surgical specimen.
