Journal of Clinical OncologyAdjuvant Radiation for Pathologically Node-Positive Prostate Cancer: Evidence When Early Salvage May Not Be Early Enough

This editorial comments on Tilki and colleagues’ “Adjuvant Versus Early Salvage Radiation Therapy After Radical Prostatectomy for pN1 Prostate Cancer and the Risk of Death.” Those researchers found that adjuvant radiotherapy (RT) was associated with a lower all-cause mortality risk compared with early salvage RT. Yet in today’s practice environment, early salvage radiotherapy (sRT) is being broadly embraced over aRT despite a continuous lack of randomized data for certain high-risk groups. The editorialist recommends that “all patients with pN1 prostate cancer—and particularly those with increasing node positivity— should be counseled on the potential survival benefits of upfront adjuvant RT demonstrated in this study and the risk that early salvage RT may not be early enough.”