Early Salvage Therapy for Patients With Advanced Features for Biochemical Relapse After Radical Prostatectomy for Localized Prostate Carcinoma In Correlation With Supposed Molecular-genetic Parameters of Higher Aggressiveness

Inclusion criteria

• > 18 years of age
• Pathologically confirmed invasive prostate carcinoma with minimal 1 risk factor (RF) after radical prostatectomy (RP)
• Patient refuses the adjuvant therapy after normalization of urinary function within 6 month after RP
• Signed informed consent to participate in the study and (where necessary) consent to participate in the translational part of the research (not a requirement)
• ECOG 0 - 1
• pT2 and minimal 1 risk factor (RF):

• R1 (PSM), and/or
• Gleason score (4+3=7) 8-10 and/or ISUP grade group 3-5
• pT3a /pT3b with or without one RF
• No evidence of suspicious pelvic lymph nodes by initial diagnostic: cN0 and/or pN0
• No evidence of suspicious distant metastases by initial diagnostic: M0
• Patient with decline of PSA level to undetectable PSA levels (< 0,1 ng/ml) or around 0,2ng/ml and with another decreasing trends so that the PSA level decline within 12-24 weeks after RP to undetectable levels (< 0,1 ng/ml) and with renewed increase of PSA >0,2 ng/ml (BCR= biochemical relapse) without any clinical relapse on PSMA PET/CT
• No hormonal therapy prior and /or after the radical prostatectomy
• Patient suitable and fit for subsequent radiotherapy with high likelihood of good compliance to the follow-up

Exclusion criteria

• Life expectancy (based on Charlson comorbidity index) < 10 years
• Patient not fit for the therapy
• History of other cancer (other than a radically removed non-melanoma skin carcinoma)
• Previous pelvic irradiation
• Active immunosuppressive medication
• History of hormone therapy prior to randomization
• cN1 and/or pN1 and M1
• PSA-persistence after RP (PSA 12-weeks after RP > 0.1 ng/ml or no decreasing trend described in Inclusion criteria)