Salvage radiotherapy (RT) to the prostate bed is a standard approach for men with prostate-specific antigen (PSA) failure after radical prostatectomy. It achieves biochemical control in approximately half of cases, and is thought to improve overall survival . The addition of hormone therapy to RT enhances the efficacy of primary treatment , but until now it was not clear whether it also improved outcomes after salvage RT. In this issue of European Urology, Spratt et al  review the two randomised trials addressing this issue. They rightly focus more on the RTOG 9601 trial  because the longer follow-up provides more data on clinically meaningful long-term outcomes. The results clearly prove the principle that addition of hormone therapy can improve clinical outcomes after salvage RT of the prostate bed. Among men receiving RT alone, half of the deaths so far were from prostate cancer (64/131). Among those receiving bicalutamide in addition, one-third of the deaths so far were from prostate cancer (34/ 108). The point estimate for the absolute benefit of 2 yr of adjuvant bicalutamide was 5% for overall survival and 8% for cause-specific survival. Given that bicalutamide is both cheap and well tolerated, this is a substantial benefit. Treating just 13 men with bicalutamide to prevent one of them dying from prostate cancer is worthwhile.
Parker, C., & Sydes, M. R. (2018, February 1). Salvage Treatment After Radical Prostatectomy. European Urology. Elsevier B.V. https://doi.org/10.1016/j.eururo.2017.07.025