Physician beliefs and practices for adjuvant and salvage radiation therapy after prostatectomy

Int J Radiat Oncol Biol Phys. 2012 Feb 1;82(2):e233-8. doi: 10.1016/j.ijrobp.2011.04.003. Epub 2011 May 24.


Purpose: Despite results of randomized trials that support adjuvant radiation therapy (RT) after radical prostatectomy (RP) for prostate cancer with adverse pathologic features (APF), many clinicians favor selective use of salvage RT. This survey was conducted to evaluate the beliefs and practices of radiation oncologists (RO) and urologists (U) regarding RT after RP.

Methods and materials: We designed a Web-based survey of post-RP RT beliefs and policies. Survey invitations were e-mailed to a list of 926 RO and 591 U. APF were defined as extracapsular extension, seminal vesicle invasion, or positive surgical margin. Differences between U and RO in adjuvant RT recommendations were evaluated by comparative statistics. Multivariate analyses were performed to evaluate factors predictive of adjuvant RT recommendation.

Results: Analyzable surveys were completed by 218 RO and 92 U (overallresponse rate, 20%). Adjuvant RT was recommended based on APF by 68% of respondents (78% RO, 44% U, p <0.001). U were less likely than RO to agree that adjuvant RT improves survival and/or biochemical control (p < 0.0001). PSA thresholds for salvage RT were higher among U than RO (p < 0.001). Predicted rates of erectile dysfunction due to RT were higher among U than RO (p <0.001). On multivariate analysis, respondent specialty was the only predictor of adjuvant RT recommendations.

Conclusions: U are less likely than RO to recommend adjuvant RT. Future research efforts should focus on defining the toxicities of post-RP RT and on identifying the subgroups of patients who will benefit from adjuvant vs. selective salvage RT.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Analysis of Variance
  • Attitude of Health Personnel
  • Erectile Dysfunction / etiology
  • Health Care Surveys / methods
  • Humans
  • Male
  • Practice Patterns, Physicians'*
  • Prostate-Specific Antigen / blood
  • Prostatectomy / statistics & numerical data
  • Prostatic Neoplasms / radiotherapy*
  • Prostatic Neoplasms / surgery
  • Radiation Oncology / statistics & numerical data*
  • Radiotherapy, Adjuvant / adverse effects
  • Radiotherapy, Adjuvant / psychology
  • Radiotherapy, Adjuvant / statistics & numerical data*
  • Radiotherapy, Conformal / statistics & numerical data
  • Radiotherapy, Intensity-Modulated / statistics & numerical data
  • Salvage Therapy / adverse effects
  • Salvage Therapy / psychology
  • Salvage Therapy / statistics & numerical data*
  • United States
  • Urology / statistics & numerical data*


  • Prostate-Specific Antigen