Easy A.

This editorial, while appreciating the efforts of the AUA/ASTRO post-prostatectomy guidelines panel, takes issue with most of their updated guidelines. Beyond a lack of any recommendations on timing of adjuvant and/or salvage radiation, they save all the love for a grade A recommendation for ADT to be given with all salvage radiation. The issue with this blanket statement is that it is largely based on RTOG 96-01, which comprised almost exclusively patients with persistently elevated PSA (44%) and/or receiving late salvage at a PSA >0.5 ng/dl (59%). With ultra-sensitive PSA labs, this is not the population we are treating today. What’s more, RTOG 96-01 subset analyses and GETUG-16 interaction tests clearly indicate a survival benefit with ADT is only seen at higher pre-salvage PSA levels. TBL: Despite the easy A dolled out by AUA/ASTRO guidelines, there is poor evidence that men receiving early salvage see any survival advantage with the addition of ADT. | Spratt, Pract Radiat Oncol 2019