Platinum Priority – Collaborative Review – Prostate Cancer Editorial by Christopher C. Parker and Matthew R. Sydes on pp. 1044–1045 of this issue Early Salvage Radiotherapy Following Radical Prostatectomy David Pfister a, *, Michel Bolla b , Alberto Briganti c , Peter Carroll d , Cesare Cozzarini e , Steven Joniau f , Hein van Poppel f , Mack Roach g , Andrew Stephenson h , Thomas Wiegel i , Michael J. Zelefsky j a Department of Urology, RWTH Aachen University, Aachen, Germany; b Department of Radiation Oncology, Centre Hospitalier Universitaire A Michallon, Grenoble, France; c Department of Urology, Universita ` Vita-Salute San Raffaele, Milan, Italy; d Department of Urology and Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, USA; e Department of Radiotherapy, San Raffaele Scientific Institute, Milan, Italy; f Department of Urology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium; g Department of Radiation Oncology and Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, USA; h Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA; i Department of Radiation Oncology, University Hospital, Ulm, Germany; j Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA 1. Introduction There is an increasing trend towards using surgical therapy to address locally advanced prostate cancer (PCa) as local control and oncologic outcome improve [1]. Nevertheless, the risk of recurrent disease after radical prostatectomy (RP), in particular for advanced stages and in patients with positive surgical margins (PSM), can range from 30% to 60% [2,3]. Recent studies have shown that about 50% of patients in the observation arm do not relapse [4–7]. Only in one prospective EUROPEAN UROLOGY 65 (2014) 1034–1043 available at www.sciencedirect.com journal homepage: www.europeanurology.com Article info Article history: Accepted August 6, 2013 Published online ahead of print on August 15, 2013 Keywords: Biochemical recurrence-free survival Early salvage radiotherapy Prostate cancer Radiotherapy Abstract Context: Depending on the pathologic tumour stage, up to 60% of prostate cancer patients who undergo radical prostatectomy will develop biochemical relapse and require further local treatment. Objectives: We reviewed the results of early salvage radiation therapy (RT), defined as prostate-specific antigen (PSA) values prior to RT  0.5 ng/ml in the setting of lymph node–negative disease. Evidence acquisition: Ten retrospective studies, including one multicentre analysis, were used for this analysis. Among them, we received previously unpublished patient characteristics and updated outcome data from five retrospective single-centre trials to perform a subgroup analysis for early salvage RT. Evidence synthesis: Patients treated with early salvage RT have a significantly improved biochemical recurrence-free survival (BRFS) rate compared with those receiving salvage RT initiated after PSA values are >0.5 ng/ml. Similarly, within the cohort of patients with pre-RT PSA values <0.5 ng/ml, improved BRFS rates were noted among those with lower rather higher pre-RT PSA levels. It is possible that higher RT dose levels and the use of adjunctive androgen-deprivation therapy improve biochemical control outcomes in the salvage setting. Conclusions: Based on a literature review, improved 5-yr BRFS rates are observed for patients who receive early salvage RT compared with patients treated with salvage RT with a pre-RT PSA value >0.5 ng/ml. Whether the routine application of early salvage RT in patients with initially undetectable PSA levels will be associated with demonstrable clinical benefit awaits the results of ongoing prospective trials. # 2013 European Association of Urology. Published by Elsevier B.V. All rights reserved. * Corresponding author. Department of Urology, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074 Aachen, Germany. Tel. +49 241 808 9374; Fax: +49 241 808 2441. E-mail address: dpfister@ukaachen.de (D. Pfister). 0302-2838/$ – see back matter # 2013 European Association of Urology. Published by Elsevier B.V. All rights reserved. http://dx.doi.org/10.1016/j.eururo.2013.08.013