"That early treatment is better than late treatment should come as no surprise, as this is a fundamental principal of oncology. In the pre-PSA era, factors were identified that predicted for a high risk of local recurrence after radical prostatectomy, most notably positive surgical margins and the absence of seminal vesicle invasion, and these also are among the strongest predictors of success of salvage radiotherapy in the present study," Dr. Anscher writes.

"Salvage radiation therapy after radical prostatectomy is a treatment that is used too infrequently and too late in the course of the disease. This is particularly true for patients who might benefit the most, namely, those with positive surgical margins and aggressive features who would go on to develop distant metastases if left untreated. Outside the context of a clinical trial, these patients should be offered early salvage therapy, i.e., as soon as an increase in the PSA levels is confirmed. Better still, these patients are candidates for adjuvant radiotherapy, which is more effective and less toxic than salvage treatment," Dr. Anscher concludes.

(JAMA. 2004;291:1380-1381. Available post-embargo at JAMA.com)

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Contact: Kimberlee Barbour
713-798-4710
JAMA and Archives Journals
16-Mar-2004