Shaping Clinical Policy for Salvage Radiotherapy After Radical Prostatectomy in Prostate Cancer: Bridging the Gap Between Clinical Trials and Daily Practice

Purpose and objective: Salvage radiotherapy (sRT) can have similar outcomes to adjuvant radiotherapy (aRT) if administered at the earliest evidence of biochemical recurrence. RADICALS-RT was the first trial to support this hypothesis and a policy of observation after radical prostatectomy (RP) with early sRT has become the new standard of care since then. This study assessed the impact of RADICALS-RT in the clinical practice regarding the timing of sRT for prostate cancer initially treated with RP.

Methods: Data from 297 patients who underwent sRT after radical RP were retrospectively collected. Two groups were created and analyzed on the basis of the date of RADICALS-RT presentation at ESMO. After these results were released in October 2021, our institutional postoperative radiotherapy policy was revisited, and a third group was created and analyzed separately.

Results: Median PSA for Groups 1, 2, and 3 were 0.33, 0.27, and 0.2, respectively. Less than one-third of patients in Groups 1 and 2 had a postoperative PSA of 0.2 ng/mL or less at the time of sRT. Group 3 showed statistically significant differences in median PSA at the time of sRT compared with Groups 1 and 2.

Conclusions: RADICALS-RT demonstrated a significant impact on clinical practice only after being complemented with real local evidence.