Adjuvant And Salvage Radiotherapy After Prostatectomy

Publication Date: April 1, 2019
Last Updated: March 14, 2022

Guideline Statements

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 and that these findings may suggest a potential benefit of additional therapy after surgery. (Clinical Principle)

Patients with adverse pathologic findings including seminal vesicle invasion, positive surgical margins, and extraprostatic extension should be informed that adjuvant radiotherapy, compared to radical prostatectomy only, reduces the risk of biochemical recurrence, local recurrence, and clinical progression of cancer. They should also be informed that the impact of adjuvant radiotherapy on subsequent metastases and overall survival is less clear; one of three randomized controlled trials that addressed these outcomes indicated a benefit but the other two trials did not demonstrate a benefit. However, these two trials were not designed to identify a significant reduction in metastasis or death with adjuvant radiotherapy. (Clinical Principle)

Physicians should offer adjuvant radiotherapy to patients with adverse pathologic findings at prostatectomy including seminal vesicle invasion, positive surgical margins, or extraprostatic extension because of demonstrated reductions in biochemical recurrence, local recurrence, and clinical progression. (Standard, A)

Patients should be informed that the development of a PSA recurrence after surgery is associated with a higher risk of development of metastatic prostate cancer or death from the disease. Congruent with this clinical principle, physicians should regularly monitor PSA after radical prostatectomy to enable early administration of salvage therapies if appropriate. (Clinical Principle)

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. (Recommendation, C)

A restaging evaluation in the patient with a PSA recurrence may be considered. (Option, C)

Physicians should offer salvage radiotherapy to patients with PSA or local recurrence after radical prostatectomy in whom there is no evidence of distant metastatic disease. (Recommendation, C)

Patients should be informed that the effectiveness of radiotherapy for PSA recurrence is greatest when given at lower levels of PSA. (Clinical Principle)

Clinicians should offer hormone therapy to patients treated with salvage radiotherapy (postoperative PSA >0.20 ng/mL) Ongoing research may someday allow personalized selection of hormone or other therapies within patient subsets. (Standard, A)

Patients should be informed of the possible short-term and long-term urinary, bowel, and sexual side effects of radiotherapy as well as of the potential benefits of controlling disease recurrence. (Clinical Principle)

Recommendation Grading




Adjuvant And Salvage Radiotherapy After Prostatectomy

Authoring Organizations

Publication Month/Year

April 1, 2019

Last Updated Month/Year

December 5, 2022

Supplemental Implementation Tools

Document Type


External Publication Status


Country of Publication


Document Objectives

The purpose o f this guideline is to provide direction to clinicians and patients regarding the use of radiotherapy after radical prostatectomy in the adjuvant or salvage setting. The strategies and approaches recommended in the guideline were derived from evidencebased and consensus-based processes. This document constitutes a clinical strategy; therefore, the most effective treatment approach for a particular patient is best determined by the patient, his family, and a multi-disciplinary team of providers using the shared decision-making model. This guideline amendment incorporates newly-published literature into the original ASTRO/AUA Adjuvant and Salvage Radiotherapy after Prostatectomy Guideline and to provide an updated clinical framework for clinicians.

Target Patient Population

Patients with prostate cancer

Inclusion Criteria

Male, Adolescent, Adult, Older adult

Health Care Settings

Ambulatory, Hospital, Operating and recovery room, Outpatient, Radiology services

Intended Users

Nurse, nurse practitioner, physician, physician assistant


Counseling, Assessment and screening, Diagnosis, Management, Treatment

Diseases/Conditions (MeSH)

D011467 - Prostate, D018787 - Radiation Oncology, D011827 - Radiation, D020728 - Transurethral Resection of Prostate, D011468 - Prostatectomy


prostate cancer, radiation therapy, Adjuvant Radiation Therapy, prostatectomy

Source Citation

2019 American Urological Association Education and Research, Inc.®


Number of Source Documents
Literature Search Start Date
January 1, 1990
Literature Search End Date
December 1, 2017