TY - JOUR T1 - Early salvage versus adjuvant therapy for treatment of prostate cancer following prostatectomy JF - BMJ Evidence-Based Medicine JO - BMJ EBM DO - 10.1136/bmjebm-2020-111592 SP - bmjebm-2020-111592 AU - Meera Garriga AU - Felix Y Feng AU - W Robert Lee AU - Julian C Hong Y1 - 2020/12/23 UR - http://ebm.bmj.com/content/early/2020/12/23/bmjebm-2020-111592.abstract N2 - The prospective adaptive meta-analysis by the ARTISTIC collaboration did not demonstrate that adjuvant radiotherapy following radical prostatectomy improves event-free survival over early salvage radiotherapy. Early salvage is preferred over adjuvant therapy to reduce overtreatment and associated side effects.In patients with localised prostate cancer, the goal of radical prostatectomy is to remove the entire primary tumour. This goal is reached in some patients, but in others, cancerous tissue may be left behind. To protect against local recurrence in high-risk patients, the prostate bed is commonly irradiated after radical prostatectomy. However, the optimal timing of radiotherapy—whether immediately postprostatectomy (adjuvant) or after early biochemical evidence of recurrence (early salvage)—has been the subject of ongoing debate. Recent guidelines1 2 recommend that adjuvant radiotherapy be offered to patients with adverse pathological findings at prostatectomy, although adjuvant radiotherapy is uncommonly used in practice.3Randomised trials conducted between 1988 and 2004 showed that in men with high-risk prostate cancer, adjuvant radiotherapy significantly reduced the risk of biochemical progression (identified by prostate-specific antigen (PSA)) compared with prostatectomy alone.4–6 However, the trials did not show a consistent increase in overall survival, and most men in the non-adjuvant groups never received salvage radiotherapy. Given these limitations and the risks … ER -