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Urology: Post-prostatectomy radiotherapy timing (RADICALS-RT)

Free question published 17 October 2026

UrologyPost-prostatectomy radiotherapy timing (RADICALS-RT)

A 63-year-old man has undergone radical prostatectomy for pT3a N0 prostate cancer with a positive surgical margin and Gleason 4+3=7. His first postoperative PSA is undetectable at less than 0.1 ng/mL. He is reviewed in clinic and asks whether he should have radiotherapy now. What is the most appropriate recommendation?

  1. AAdjuvant radiotherapy plus 2 years of androgen deprivation therapy
  2. BImmediate androgen deprivation therapy alone
  3. CObservation with PSA monitoring and early salvage radiotherapy on biochemical progression
  4. DImmediate adjuvant radiotherapy to the prostate bed
  5. EWhole-pelvis adjuvant radiotherapy regardless of PSA

Why C is correct

RADICALS-RT compared adjuvant radiotherapy with an observation policy plus early salvage radiotherapy for PSA biochemical progression. There was no difference in biochemical progression-free survival, but adjuvant radiotherapy increased urinary morbidity. The trial concluded that an observation policy with salvage radiotherapy for PSA biochemical progression should be the current standard after radical prostatectomy, sparing many men radiotherapy.

And why the others are not

  • AIncorrect: routine adjuvant radiotherapy with prolonged ADT is not supported as standard by RADICALS-RT in this scenario.
  • BIncorrect: ADT alone is not indicated for an undetectable PSA after prostatectomy and does not address local control.
  • DIncorrect: adjuvant radiotherapy gave no biochemical control benefit over early salvage and increased urinary morbidity.
  • EIncorrect: routine whole-pelvis adjuvant radiotherapy is not supported and overtreats men who may never relapse.

Source RADICALS-RT — Timing of radiotherapy after radical prostatectomy — Parker CC, Clarke NW, Cook AD, et al. Timing of radiotherapy after radical prostatectomy (RADICALS-RT): a randomised, controlled phase 3 trial. Lancet 2020;396(10260):1413-1421.

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