Do you forgo adjuvant radiotherapy for men with pT3 prostate cancer who have significant urinary incontinence?

I agree that early salvage may be reasonably effective and thus one might carefully observe patients who are not ideal candidates for adjuvant RT. Both the RADICALS study and the RAVES study will examine this issue (timing of post-op RT further). Here's a recent summary of the RAVES trial:

This is a pretty common problem that we, as radiation oncologists, face on a regular basis, and the approach needs to be individualized. It is not unusual for a patient to require 3-6 months, or more, to recover continence after radical prostatectomy. I find that I rarely start adjuvant RT before 3 months, in order to allow for recovery of continence. I have waited as long as 12 months, but beyond that point in time, spontaneous recovery of continence is rare, and you'll need to decide whether t...

On the matter of continence recovery, there is a Belgian paper that studied a subset of 100 men enrolled on the Bolla postop EORTC study (Van Cangh et al). Continence recovery within 3-4 mo after surgery was not a prerequisite to be enrolled. Using a validated measure of continence (pad weight), men given adjuvant RT did not demonstrate inferior continence recovery compared to men observed through 2 years of follow-up. So, poor recovery of continence should not necessarily be the sole factor dri...

The true benefit of adjuvant RT for T3 disease is questioned because all the published trial compared adjuvant vs. no adjuvant rather than adjuvant vs. early salvage. This is part of an ongoing study. So if a patient has significant urinary problems, we would rather closely observe with serial PSA and treat with salvage if he develops biochemical recurrence. This way, we can avoid treating a significant number of these patients and avoid adding any additional morbidity.

Seems like everyone here is on mark. I agree with Howard to be cautious about gambling, especially with GS 8-10. It may also be useful to consider incontinence recovery rates after RP: 65% at 6 months, and 80% by 12 months.

http://www.ncbi.nlm.nih.gov/pubmed/25682782