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    Trends raise post-RP RT guide’s relevance

    ASCO endorsement emphasizes individualizing patient risk-benefit ratio

    In May 2013, the American Urological Association (AUA) and the American Society for Radiation Oncology (ASTRO) released a joint guideline for radiotherapy after prostatectomy (J Urol 2013; 190:441-9). As a framework for practitioners caring for men who undergo surgery for treatment of prostate cancer, the evidence-based guideline contains nine statements that address use of adjuvant and salvage radiotherapy, conduct of a restaging evaluation, patient counseling, and a definition for biochemical recurrence (table).

    Read - Prostate cancer guidelines: A primer for urologists

    In November 2014, and after conducting an updated literature search, a panel from the American Society of Clinical Oncology (ASCO) published an endorsement of the AUA/ASTRO radiotherapy guideline (J Clin Oncol 2014; 32:3892-8). In their report, the ASCO endorsement panel stated the AUA/ASTRO guidelines were “clear, thorough, and based on the most relevant scientific evidence,” but they included some qualifying statements further underscoring the importance of informed shared decision-making as well as taking into account that the risk-benefit ratio of radiotherapy after prostatectomy differs among individuals.

    Today and into the near future, urologists are likely to be encountering a growing population of men for whom adjuvant or salvage radiotherapy after prostatectomy is a relevant consideration.

    Whereas historically, about one-half of men diagnosed with prostate cancer undergo prostatectomy, about one-third of those patients might be considered candidates for adjuvant radiation based on risk stratification, and about one-third of men develop a recurrence within a decade after prostatectomy, the landscape is changing.

    An increasing number of studies investigating the impact of the 2012 U.S. Preventive Services Task Force recommendation against prostate-specific antigen (PSA)-based screening for prostate cancer have documented a shift toward the diagnosis of higher risk prostate cancers. Increased acceptance of the recommendation for active surveillance by men with low-grade, low-stage tumors is also contributing to an increase in patients who have higher risk disease at the time of prostatectomy.

    Also see - CRPC document aids in complex decisions

    Considering these trends, the importance of practitioners becoming familiar with the content of the AUA/ASTRO guideline and ASCO endorsement is heightened.

    Next: Guideline development

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