When recommending salvage RT post-prostatectomy for an ultra-sensitive PSA level <0.1, do you still recommend concurrent hormonal therapy?

There is potentially an interaction between ADT's benefit and the PSA at the time of treatment. This was most well delineated in RTOG 9601 (Dess et al., PMID 32215583), but since then, using modern LHRH agonists, that interaction has been less well established (GETUG-AFU16, SPPORT, and RADICALS-HD)....

The recently published AUA/ASTRO/SUO guidelines on salvage therapy for prostate cancer discuss this scenario (AUA/ASTRO/SUO Salvage Therapy for Prostate Cancer Guideline Part I), (AUA/ASTRO/SUO Salvage Therapy for Prostate Cancer Guideline Part II), (AUA/ASTRO/SUO Salvage Therapy for Prostate Cancer...

After radical prostatectomy more than 40% of patients with intermediate or high-risk prostate cancer may experience biochemical recurrence, however, not all patients with PSA recurrence or persistence develop metastases or die from disease. Clinical markers of local versus distant disease should inc...

Parker et al., Annals of Oncology 2022
Although not published RADICALS included adjuvant and salvage patients after RP randomizing those who got RT to 0 vs y vs 24 months ADT. It showed long-term ADT improved MFS. So if the patient otherwise has high-risk prostate cancer when treating with salvage R...

The decision to recommend concurrent hormonal therapy with salvage RT at an ultra-sensitive PSA level should be individualized, taking into account the patient's risk factors, potential benefits, and side effects of treatment.

When considering salvage radiotherapy (RT) post-prostatectomy, especially ...

Agree with many of the comments above. I would consider adding ADT for detectable PSA <0.1 in patients with pT4, pN+, or GG5 disease who were under-represented or ineligible for enrollment on the major adjuvant vs salvage trials and overall are at higher risk of recurrence. Additionally, for all pat...