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In Reply: Drs Ward and Blute point out that patients with positive surgical margins have highly variable outcomes, and the acute and late toxicity of postprostatectomy radiation therapy is not trivial. In the absence of conclusive evidence demonstrating a benefit, we do not believe that adjuvant radiotherapy is preferable to careful observation and salvage radiotherapy at the time of documented PSA recurrence. Adjuvant radiotherapy for patients with positive surgical margins exposes many patients whose disease would never have recurred to the toxicity of radiation therapy. Furthermore, given the sensitivity of modern PSA assays, which has blurred the line between salvage and adjuvant radiation therapy, it is increasingly uncertain whether a window of opportunity for cure is lost when high-risk patients are observed and treated at the earliest evidence of recurrent disease.

We believe that the 4-year rate of disease progression we reported provides a reasonable end point to evaluate the . . . [Full Text of this Article]

Andrew J. Stephenson, MD
Department of Urology
Sidney Kimmel Center for Prostate and Urologic Cancers
Memorial Sloan-Kettering Cancer Center
New York, NY

Kevin M. Slawin, MD
kslawin@bcm.tmc.edu
Scott Department of Urology
Baylor College of Medicine
Houston, Tex

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