Adjuvant radiotherapy after radical prostatectomy as preventive treatment for biochemical recurrence

Adjuvant radiotherapy (RT) has proven to be more effective in patients at high risk of relapse than salvage RT when this relapse occurs. To optimize its use we must identify the subset of patients at greater risk of residual microscopic disease after surgery, since in them the likelihood of 5-10 year biochemical failure can reach 60%. There are many studies on the subject in which these factors are identified, which in general are: presence of positive margins and capsular or seminal vesicle involvement (T3a-b). Of these, it seems that the presence of positive margins is the most powerful predictor of relapse. With regard to radiotherapy, there is variability in the dose to give and volume treated. In general, the dose in most series is >= 60 Gy, reaching some authors up to 70 Gy. As to the association or not hormone therapy (HT) and adjuvant radiotherapy it is a subject of debate and so far no results of studies demonstrate a sufficient benefit, so it should be individualized, weighing potential benefits in high risk patients against side effects.