The Absolute Effect / Prostate Cancer / Radiation
After radical prostatectomy in men with adverse pathology, is immediate adjuvant radiotherapy superior to early salvage radiotherapy when both strategies use short-term ADT?
424 men with pT3a, pT3b or pT4a disease, pNx or pN0 disease and positive margins; randomized phase III trial. All patients received 6 months of triptorelin.
At 5 years, event-free survival was 92% with adjuvant RT versus 90% with early salvage RT: absolute difference 2 percentage points; HR 0.81 (95% CI 0.48–1.36), p=0.42. The trial stopped early because event rates were lower than expected, so it was underpowered.
Late grade ≥2 GU toxicity was 59% with adjuvant RT versus 22% with salvage RT: +37 percentage points, approximate NNH 3 over the reported follow-up. Grade ≥2 erectile dysfunction was 28% versus 8%: +20 points, NNH ≈5. Acute grade ≥3 toxicity was 3% versus 2%.
GETUG-AFU 17 directly tests treatment timing in the modern early-salvage context. It did not show an EFS advantage for routine adjuvant RT, while exposing more men to late urinary and sexual toxicity.
GETUG-AFU 17 is part of the randomized evidence base supporting an early-salvage policy rather than routine adjuvant RT for most men with adverse pathology after prostatectomy, because many can avoid RT and its urinary/sexual toxicity. Decisions remain individualized for exceptionally high-risk pathology, PSA persistence, postoperative PSA kinetics and patient preferences. The trial used six months of triptorelin in both arms, so its comparison is RT timing under that shared hormonal strategy.
GETUG-AFU 17 primary report ↗ · EAU prostate-cancer guidance ↗