Biochemical relapse after radical prostatectomy occurs in approximately 15–40% of patients within 5 years. Postoperative radiotherapy is the only curative treatment for these patients. After radical prostatectomy, two different strategies can be offered, adjuvant or salvage radiotherapy. Adjuvant radiotherapy is defined as treatment given directly after surgery in the presence of risk factors (R1 resection, pT3) before biochemical relapse occurs. It consists of 60–64？Gy and was shown to increase biochemical relapse-free survival in three randomized controlled trials and to increase overall survival after a median followup of 12.7 years in one of these trials. Salvage radiotherapy, on the other hand, is given upon biochemical relapse and is the preferred option, by many centers as it does not include patients who might be cured by surgery alone. As described in only retrospective studies the dose for salvage radiotherapy ranges from 64 to 72？Gy and is usually dependent on the absence or presence of macroscopic recurrence. Randomized trials are currently investigating the role of adjuvant and salvage radiotherapy. Patients with biochemical relapse after prostatectomy should at the earliest sign of relapse be referred to salvage radiotherapy and should preferably be treated within a clinical trial. 1. Introduction Radical prostatectomy (RP) provides excellent cancer control in patients with localized prostate cancer. However, half of all patients present with one or more risk factors for recurrent disease including higher Gleason Score, extracapsular extension (TNM tumor classification pT3a), invasion of the seminal vesicles (pT3b), or positive resection margins (R1). As a result, the risk of biochemical relapse is approximately 15–40% 5 years after RP [1, 2] and still increasing later [3] with even higher significance for patients with initially markedly elevated prostate-specific antigen (PSA) values [4, 5]. In patients with biochemical relapse, median time to bone metastasis is 8 years [6]. It is more pronounced with PSA doubling time of <12 months, resulting in a 5-year metastatic progression-free survival of less than 20% [7]. From several trials, nomograms have been created to assess the risk of an individual patient for tumor progression [8, 9]. This documents the importance of adequate selection of men after curative intended local treatment of prostate cancer. Postoperative radiotherapy (RT) can be performed directly after RP based on risk factors (adjuvant RT), or it is performed in case of biochemical relapse after RP or in patients who have
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