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In Reply: I agree with Drs Ward and Blute that there are few randomized trials dealing with any aspect of the diagnosis and management of this common disease. Thus, physicians often have no recourse but to refer to retrospective data and basic principles of oncology when recommending treatments to patients with prostate cancer. One such principle is that positive surgical margins require additional treatment to prevent the inevitable recurrence of disease.

I implied that adjuvant radiotherapy significantly improves disease-free survival compared with salvage radiotherapy for patients with pathologic stage T3 prostate cancer, but space constraints prevented me from presenting specific data. I am aware, however, of at least 6 different studies^1-6 that have reported that patients receiving adjuvant radiotherapy had significantly improved disease-free survival compared with patients treated with salvage therapy.

Ward and Blute state that the decision to use any therapy in the adjuvant setting requires a thorough understanding . . . [Full Text of this Article]

Mitchell S. Anscher, MD
anscher@radonc.duke.edu
Department of Radiation Oncology
Duke University Medical Center
Durham, NC

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