ASTRO, AUA issue prostate radiation therapy guideline

The American Society for Radiation Oncology (ASTRO) and the American Urological Association (AUA) have published a joint guideline for the practice of radiation therapy after prostatectomy for patients with and without evidence of prostate cancer recurrence.

The ASTRO/AUA guideline was produced following a comprehensive literature review. It provides the following clinical principles, recommendations, standards, and options:

1. Patients who are being considered for management of localized prostate cancer with radical prostatectomy should be informed of the potential for adverse pathologic findings that portend a higher risk of cancer recurrence.
2. Patients with adverse pathologic findings including seminal vesicle invasion, positive surgical margins, and extraprostatic extension should be informed that adjuvant radiation therapy, compared to radical prostatectomy only, reduces the risk of prostate-specific antigen (PSA) recurrence, local recurrence, and clinical progression of cancer.
3. Physicians should offer adjuvant radiation therapy to patients with adverse pathologic findings at the time of prostatectomy, including seminal vesicle invasion, positive surgical margins, or extraprostatic extension because of demonstrated reductions in biochemical recurrence, local recurrence, and clinical progression.
4. Patients should be informed that the development of a PSA recurrence after surgery is associated with a higher risk of developing metastatic prostate cancer or death from the disease.
5. Clinicians should define biochemical recurrence as a detectable or rising PSA value after surgery that is ≥ 0.2 ng/mL with a second confirmatory level ≥ 0.2 ng/mL.
6. A restaging evaluation in the patient with a PSA recurrence may be considered.
7. Physicians should offer salvage radiation therapy to patients with PSA or local recurrence after radical prostatectomy in whom there is no evidence of distant metastatic disease.
8. Patients should be informed that the effectiveness of radiation therapy for PSA recurrence is greatest when given at lower levels of PSA.
9. Patients should be informed of the possible short-term and long-term urinary, bowel, and sexual side effects of radiation therapy, as well as the potential benefits of controlling disease recurrence.

The 81-page document is available for free as a PDF document here and here.