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Radical prostatectomy with or without EBRT
Source: Prostate Cancer Treatment (PDQ®)–Health Professional Version, National Cancer Institute.
Source updated: May 14, 2025 · Captured 2026-09-09.
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Context: Treatment of Stage III Prostate Cancer / Treatment Options for Stage III Prostate Cancer
Radical prostatectomy may be used with or without EBRT (in highly selected patients).[42] Because about 40% to 50% of men with clinically organ-confined disease are found to have pathological extension beyond the prostate capsule or surgical margins, the role of postprostatectomy adjuvant radiation therapy has been studied.
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Evidence (radical prostatectomy with or without EBRT):
In a randomized trial of 425 men with pathological T3, N0, M0 disease, postsurgical EBRT (60–64 Gy to the prostatic fossa over 30–32 fractions) was compared with observation.[43,44]
In a randomized trial of 425 men with pathological T3, N0, M0 disease, postsurgical EBRT (60–64 Gy to the prostatic fossa over 30–32 fractions) was compared with observation.[43,44]
After a median follow-up of about 12.5 years, OS was better in the radiation therapy arm; HRdeath, 0.72 (95% CI, 0.55–0.96; P = .023). The 10-year estimated survival rates were 74% in the radiation therapy arm and 66% in the control arm.
In a randomized trial of 425 men with pathological T3, N0, M0 disease, postsurgical EBRT (60–64 Gy to the prostatic fossa over 30–32 fractions) was compared with observation.[43,44]
The 10-year estimated metastasis-free survival rates were 73% and 65% (P = .016).[44][Level of evidence A1]
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In a randomized trial of 425 men with pathological T3, N0, M0 disease, postsurgical EBRT (60–64 Gy to the prostatic fossa over 30–32 fractions) was compared with observation.[43,44]
Short-term complication rates were substantially higher in the radiation therapy group: overall complications were 23.8% versus 11.9%, rectal complications were 3.3% versus 0%, and urethral stricture was 17.8% versus 9.5%.
In a randomized trial of 425 men with pathological T3, N0, M0 disease, postsurgical EBRT (60–64 Gy to the prostatic fossa over 30–32 fractions) was compared with observation.[43,44]
The role of preoperative (neoadjuvant) hormonal therapy is not established.[45,46] Also, the morphologic changes induced by neoadjuvant androgen ablation may even complicate assessment of surgical margins and capsular involvement.[47]
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Preserved source evidence · Not medical advice