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ASTRO And AUA Issue Joint Guideline For Radiation Therapy After Prostatectomy

The guideline document 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 biochemical (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 development of 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 greater than or equal to 0.2 ng/ml with a second confirmatory level greater than or equal to 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; and 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.

In addition to Drs. Valicenti and Thompson, authors of the The Adjuvant and Salvage Radiotherapy After Prostatectomy: ASTRO/AUA Guideline include Eric A. Klein, MD, of the Cleveland Clinic; S. Larry Goldenberg, MD, of the Vancouver Prostate Centre at the University of British Columbia; Peter C. Albertsen, MD, of the University of Connecticut Health Center; Jeff M. Michalski, MD, MBA, FASTRO, of the Siteman Cancer Center at the Washington University School of Medicine in St. Louis; Mack Roach, III, MD, of the Helen Diller Family Comprehensive Cancer Center at the University of California, San Francisco; Oliver Sartor, MD, of the Tulane University School of Medicine; Brian J. Davis, MD, PhD, of the Mayo Clinic; and Martha Faraday, PhD, of Four Oaks Inc.

 "This guideline explicitly includes a multitude of significant clinical trial results from more than 20 years of thorough research," said Dr. Valicenti. "There is a critical need for evidence-based standards, recommendations and options to maximize our ultimate goal of increased patient survival and quality of life. This guideline is a compendium of the vast wealth of research available and provides a thorough treatment template for us to consider for prostate cancer patients after a radical prostatectomy."

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