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Post-operative radiotherapy is now standard care in T3 disease

In a randomised SWOG trial presented at the 47th meeting of the American Society for Therapeutic Radiology, 425 men with positive margins in the surgical resection specimen after radical prostatectomy, were randomised either to receive post-operative radiotherapy or not. With a median age of 65 years and a median follow up of ten years, the results are powerful and the population typical. In terms of biochemical (PSA) relapse - i.e. a rise in the PSA - there was a clear advantage to early radiotherapy. Thus, the biochemical relapse free survival was 84% versus 69% at five years and 68% versus 49% at ten years; the overall survival was not significantlt different but this may be expected to come with more patients reaching the later time point. Early post-operative radiotherapy is now standard care where, by accepting a patient for surgery, who is actually T3 at the outset , the clinicians are left with a post-operative situation of trans-capsular disease.