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Prostate BCR — SCE Medical Oncology MCQ

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ModerateUrological CancersProstate BCRSCE Medical Oncology

A 60-year-old man with high-risk localised prostate cancer (Gleason 4+5=9, PSA 25, T3a) undergoes radical prostatectomy with extended pelvic lymph node dissection. Post-operative PSA is undetectable but rises to 0.3 ng/mL at 6 months. This is defined as biochemical recurrence. What treatment should be discussed?

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Correct answer: D — Salvage radiotherapy to the prostate bed ± short-term ADT

Biochemical recurrence after radical prostatectomy (PSA ≥0.2 ng/mL with confirmatory rise) should prompt consideration of salvage radiotherapy (SRT) to the prostate bed (64-66 Gy), ideally while PSA is still low (<0.5 ng/mL). The RADICALS-RT, GETUG-AFU 17 and RAVES trials showed SRT at BCR is equivalent to adjuvant RT in preventing metastasis-free survival events, while sparing many men unnecessary radiation. Short-course ADT (6 months, RTOG 9601) combined with SRT improves OS in men with PSA >0.7 ng/mL.

Reference: ESMO 2024 Prostate Cancer Guidelines; RADICALS-RT Parker et al Lancet 2020; RTOG 9601 Shipley et al NEJM 2017