The American Urological Association and the American Society for Radiation Oncology have issued a joint guideline for the use of radiation therapy after radical prostatectomy (RP) for patients with and without evidence of prostate cancer recurrence, published in The Journal of Urology (2013;190:441-449) and in the International Journal of Radiation Oncology, Biology, Physics (2013;86:822-828).

The guideline recommends that patients with adverse pathologic findings at prostatectomy (seminal vesicle invasion, positive surgical margins, extraprostatic extension) should be offered adjuvant radiotherapy and should be informed that compared with RP alone, adjuvant radiation therapy reduces the risk for biochemical recurrence, local recurrence, and clinical progression of cancer.

Salvage radiotherapy should be offered to patients with biochemical or local recurrence after RP in whom there is no evidence of distant metastatic disease. Clinicians should define biochemical recurrence as a detectable or rising PSA value after surgery that is at least 0.2 ng/mL, with a second confirmatory level of at least 0.2 ng/mL.

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