Adjuvant and salvage radiotherapy after prostatectomy: American Society of Clinical Oncology clinical practice guideline endorsement

Stephen J. Freedland, R. Bryan Rumble, Antonio Finelli, Ronald C. Chen, Susan Slovin, Mark N. Stein, David S. Mendelson, Colin Wackett, Howard M. Sandler

Research output: Contribution to journalArticle

61 Citations (Scopus)

Abstract

Purpose: To endorse the American Urological Association (AUA)/American Society for Radiation Oncology (ASTRO) guideline on adjuvant and salvage radiotherapy after prostatectomy. The American Society of Clinical Oncology (ASCO) has a policy and set of procedures for endorsing clinical practice guidelines developed by other professional organizations. Methods: The guideline on adjuvant and salvage radiotherapy after prostatectomy was reviewed for developmental rigor by methodologists. An ASCO endorsement panel then reviewed the content and recommendations. Results: The panel determined that the guideline recommendations on adjuvant and salvage radiotherapy after prostatectomy, published in August 2013, are clear, thorough, and based on the most relevant scientific evidence. ASCO endorsed the guideline on adjuvant and salvage radiotherapy after prostatectomy, adding one qualifying statement that not all candidates for adjuvant or salvage radiotherapy have the same risk of recurrence or disease progression, and thus, risk-benefit ratios are not the same for all men. Those at the highest risk for recurrence after radical prostatectomy include men with seminal vesicle invasion, Gleason score 8 to 10, extensive positive margins, and detectable postoperative prostate-specific antigen (PSA). Recommendations: Physicians should discuss adjuvant radiotherapy with patients with adverse pathologic findings at prostatectomy (ie, seminal vesicle invasion, positive surgical margins, extraprostatic extension) and salvage radiotherapy with patients with PSA or local recurrence after prostatectomy. The discussion of radiotherapy should include possible short- and long-term adverse effects and potential benefits. The decision to administer radiotherapy should be made by the patient and multidisciplinary treatment team, keeping in mind that not all men are at equal risk of recurrence or clinically meaningful disease progression. Thus, the risk-benefit ratio will differ for each patient.

Original languageEnglish (US)
Pages (from-to)3892-3898
Number of pages7
JournalJournal of Clinical Oncology
Volume32
Issue number34
DOIs
StatePublished - Dec 1 2014

Fingerprint

Adjuvant Radiotherapy
Prostatectomy
Practice Guidelines
Radiotherapy
Guidelines
Recurrence
Medical Oncology
Seminal Vesicles
Prostate-Specific Antigen
Disease Progression
Odds Ratio
Radiation Oncology
Neoplasm Grading
Physicians

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

Cite this

Freedland, Stephen J. ; Rumble, R. Bryan ; Finelli, Antonio ; Chen, Ronald C. ; Slovin, Susan ; Stein, Mark N. ; Mendelson, David S. ; Wackett, Colin ; Sandler, Howard M. / Adjuvant and salvage radiotherapy after prostatectomy : American Society of Clinical Oncology clinical practice guideline endorsement. In: Journal of Clinical Oncology. 2014 ; Vol. 32, No. 34. pp. 3892-3898.
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abstract = "Purpose: To endorse the American Urological Association (AUA)/American Society for Radiation Oncology (ASTRO) guideline on adjuvant and salvage radiotherapy after prostatectomy. The American Society of Clinical Oncology (ASCO) has a policy and set of procedures for endorsing clinical practice guidelines developed by other professional organizations. Methods: The guideline on adjuvant and salvage radiotherapy after prostatectomy was reviewed for developmental rigor by methodologists. An ASCO endorsement panel then reviewed the content and recommendations. Results: The panel determined that the guideline recommendations on adjuvant and salvage radiotherapy after prostatectomy, published in August 2013, are clear, thorough, and based on the most relevant scientific evidence. ASCO endorsed the guideline on adjuvant and salvage radiotherapy after prostatectomy, adding one qualifying statement that not all candidates for adjuvant or salvage radiotherapy have the same risk of recurrence or disease progression, and thus, risk-benefit ratios are not the same for all men. Those at the highest risk for recurrence after radical prostatectomy include men with seminal vesicle invasion, Gleason score 8 to 10, extensive positive margins, and detectable postoperative prostate-specific antigen (PSA). Recommendations: Physicians should discuss adjuvant radiotherapy with patients with adverse pathologic findings at prostatectomy (ie, seminal vesicle invasion, positive surgical margins, extraprostatic extension) and salvage radiotherapy with patients with PSA or local recurrence after prostatectomy. The discussion of radiotherapy should include possible short- and long-term adverse effects and potential benefits. The decision to administer radiotherapy should be made by the patient and multidisciplinary treatment team, keeping in mind that not all men are at equal risk of recurrence or clinically meaningful disease progression. Thus, the risk-benefit ratio will differ for each patient.",
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Freedland, SJ, Rumble, RB, Finelli, A, Chen, RC, Slovin, S, Stein, MN, Mendelson, DS, Wackett, C & Sandler, HM 2014, 'Adjuvant and salvage radiotherapy after prostatectomy: American Society of Clinical Oncology clinical practice guideline endorsement', Journal of Clinical Oncology, vol. 32, no. 34, pp. 3892-3898. https://doi.org/10.1200/JCO.2014.58.8525

Adjuvant and salvage radiotherapy after prostatectomy : American Society of Clinical Oncology clinical practice guideline endorsement. / Freedland, Stephen J.; Rumble, R. Bryan; Finelli, Antonio; Chen, Ronald C.; Slovin, Susan; Stein, Mark N.; Mendelson, David S.; Wackett, Colin; Sandler, Howard M.

In: Journal of Clinical Oncology, Vol. 32, No. 34, 01.12.2014, p. 3892-3898.

Research output: Contribution to journalArticle

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T2 - American Society of Clinical Oncology clinical practice guideline endorsement

AU - Freedland, Stephen J.

AU - Rumble, R. Bryan

AU - Finelli, Antonio

AU - Chen, Ronald C.

AU - Slovin, Susan

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