LAUSR

Despite three large randomized controlled trials demonstrating that adjuvant radiotherapy decreases prostatespecific antigen (PSA) recurrence and may decrease metastatic progression and mortality, there has been a progressive decline in the number of patients receiving this treatment [1]. As with most treatment decisions, the choice between adjuvant and salvage radiotherapy depends on balancing the intended benefits with potential harms. The potential benefit of adjuvant radiotherapy is improved cancer control at the potential expense of treatment-related toxicity. Demonstration of equivalent oncologic outcomes would justify routine adoption of salvage radiotherapy given the potential to avoid the treatment-related inconvenience, cost, and toxicity associated with adjuvant therapy. To assess oncologic outcomes between adjuvant and early salvage radiotherapy, in this issue of European Urology Fossati and colleagues [2] report on a multi-institutional, retrospective cohort study examining metastasis-free and overall survival among patients with pT3pN0 prostate cancer with undetectable postoperative PSA levels. Unlike prior reports, salvage radiotherapy was administered at a PSA level 0.5 ng/ml according to the protocol, and the mean PSA level at the time of early salvage radiotherapy was 0.2 ng/ml, in keeping with modern ‘‘early salvage’’ radiotherapy. The authors demonstrate that adjuvant and early salvage radiotherapy were associated with similar 8-yr metastasisfree survival (92% vs 91%; p = 0.9) and overall survival (89% vs 92%; p = 0.9) [2]. This persisted after adjustment for pathologic stage, grade, margin status, and year of surgery.