What dose is most appropriate when treating a post-prostatectomy patient with positive margins in the adjuvant setting?

The data for dose response in post RP radiation is not as robust as it is in the definitive setting. All randomised trials for adjuvant treatment used mainly 60 Gy, although retrospective data in the adjuvant setting shows better outcome with dose range from 61.5 Gy to 70 Gy. Similarly in the salvage setting, there is a dose response and better outcomes for 64.8 Gy, 66.6 Gy and 70.2 Gy. All these studies have shown tolerance to treatment although all are retrospective

The ASTRO AUA guidelines sug...

In our practice we offer 64 Gy at 2/fx to the prostate bed as an adjuvant dose (i.e. PSA undetectable) for the following reasons:

1) This is consistent (but in the upper range) with the 3 randomized studies of adjuvant RT that give 60-64 Gy;

2) In the year after prostatectomy, continence may be more susceptible to radiation effects, as suggested by non-randomized Italian data that report a 50% rate of pad use for men treated with RT (median dose 70.2 Gy) vs. 20% for men not treated with any RT. Th...