Dr. Castle on Adjuvant Versus Early Salvage Therapy in Prostate Cancer

Erik P. Castle, MD, professor of urology, Mayo Clinic, discusses the use of adjuvant versus early salvage therapy in patients with prostate cancer, citing his own preference for early salvage therapy.

Though there are data that demonstrate a survival benefit in adjuvant radiotherapy in post-prostatectomy patients with high-risk features such as stage III disease, positive margins, and positive lymph nodes, Castle prefers to observe his patients and give early salvage if necessary.

There are data that have yet to be fully analyzed in ongoing and accruing clinical trials comparing early salvage to adjuvant therapy. Many patients with high-risk features were followed until they were symptomatic in the open prostatectomy series. A large percentage of patients will not recur and won’t be at risk of dying, even though they have some of these high-risk features.

Though there is a role for adjuvant therapy, especially in patients who have a high risk for recurrence and young patients who are going to need trimodality therapy, Castle advocates monitoring patients very closely in a very tight schedule of prostate-specific antigen (PSA) testing, utilizing their time to recurrence, and their PSA kinetics to determine how aggressive to be with radiation.