@adoptedtomato

Adjuvant RT - it is administered after RP with NO evidence of cancer. PSA is undetectable but RT is done as prevention of BCR

Salvage RT - is any RT in any period AFTER BCR happens OR if PSA is not undetectable immediately after RP.

So difference is not between actual "timing" but between evidence of disease present or not before RT starts.

@adoptedtomato
Actually, here’s more information on this exact subject from 2024

This information is from Dr. Eleni Efstathiou, One of the top GU oncologists in the country. She recently moved from Houston to Portland.

Adjuvant radiation
Dr. Efstathiou concluded as follows
* Early salvage radiotherapy is favored over adjuvant radiotherapy in most patients
* Consider adjuvant radiotherapy in otherwise fit, motivated, very high-risk patients with ≥2 of the following risk factors:
* pT3b-4
* Gleason score 8-10
* pN+ Lymph node Metz
* Decipher score >0.6
* In high-risk patients, use lower thresholds to initiate ‘ultra-early salvage or adjuvant-plus’ radiotherapy
* If giving adjuvant radiotherapy, it implies high-risk disease. Thus, Dr. Efstathiou would recommend treating the prostate bed and pelvic lymph nodes, in addition to short-term versus long-term ADT, depending on risk factors
* May consider genomic classifiers or artificial intelligence tools to help with informed decision-making
* The goal is to avoid (or delay) radiotherapy in those who we can, without missing a window to cure patients who are guaranteed to recur

Here is a link to the article supplied by @surftohealth88 originally
https://www.urotoday.com/conference-highlights/apccc-2024/151546-apccc-2024-debate-how-to-best-manage-a-fit-patient-with-high-risk-localised-and-locally-advanced-prostate-cancer-how-to-select-patients-for-adjuvant-therapy-after-radical-prostatectomy-and-how-to-treat-them.html

@adoptedtomato
"I keep questioning it. Researched extensively. Got more confused." Don't feel like The Lone Ranger! 🥴