What are the ASTRO-AUA guidelines on the use of external beam radiotherapy (EBRT) for the treatment of prostate cancer?

Updated: Nov 29, 2018
  • Author: Isamettin Andrew Aral, MD, MS; Chief Editor: Edward David Kim, MD, FACS  more...
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The guideline statements are as follows:

  • If a patient is undergoing radical prostatectomy for localized prostate cancer, discuss the possibility of adverse pathologic findings indicating an increased cancer recurrence risk (clinical principle)

  • If adverse pathologic signs—such as seminal vesicle invasion, positive surgical margins, and extraprostatic extension—are found, inform the patient that the risk for biochemical (prostate-specific antigen [PSA]) recurrence, local recurrence, or clinical progression of cancer is lower following a combination of radical prostatectomy and adjuvant radiation therapy than it is after radical prostatectomy alone (clinical principle)

  • If adverse pathologic signs are found at prostatectomy, offer adjuvant radiation therapy to the patient (standard; evidence strength, grade A)

  • Inform patients that PSA recurrence after surgery is associated with a higher risk for metastatic prostate cancer and with an increased mortality risk (clinical principle)

  • Biochemical recurrence should be defined as a detectable or rising postsurgery PSA value of at least 0.2 ng/mL, with a second confirmatory level of at least 0.2 ng/mL (recommendation; evidence strength, grade C)

  • A restaging evaluation should be considered in patients with a PSA recurrence (option; evidence strength, grade C)

  • Offer salvage radiation therapy to patients who, after radical prostatectomy, demonstrate PSA or local recurrence but have no distant metastatic disease (recommendation; evidence strength, grade C)

  • Inform patients that radiation therapy is most effective against PSA recurrence when PSA levels are relatively low (clinical principle).

  • Inform patients that radiation therapy may cause short- or long-term urinary, bowel, and sexual adverse effects, but also discuss the treatment’s potential benefits as a means of controlling disease recurrence (clinical principle).

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