Post-prostatectomy radiotherapy treats the prostate bed after surgery — either soon afterwards (adjuvant) or when PSA rises (salvage). The target can’t be seen, so contouring follows consensus atlases, and the bladder and rectum sit closer to the target than in intact-prostate treatment.
After radical prostatectomy there is no prostate to see. The target is the prostate bed — the space where the prostate and seminal vesicles were — defined from anatomical landmarks, surgical clips and consensus guidance rather than a visible organ.
Radiotherapy may be given soon after surgery (adjuvant) or when PSA rises (salvage). Randomized trials — RAVES and RADICALS-RT — compared those approaches. Protocols give both conventional (2 Gy per fraction) and hypofractionated (2.63 Gy per fraction) schedules, and the constraint table below has a column for each.
Without the prostate in between, the bladder and rectum wrap more closely around the target, and post-surgical anatomy (the vesicourethral anastomosis, clips, altered bladder shape) needs careful review on the planning CT.
A consistent, comfortably full bladder and an empty rectum, as for definitive treatment.
The bladder moves the anterior prostate bed with filling, and the rectum sits directly behind it; consistency from day to day matters as much as in intact-prostate treatment.
Image fusion aligns an outside scan with the planning CT so the target can be drawn using information the CT doesn't show. Before salvage treatment to the prostate bed, a PSMA PET is recommended — particularly when the PSA is 0.2 ng/mL or higher — and a pelvic MRI when a local recurrence is seen.
PSMA PET can show where the recurrence is — in the bed, the pelvic nodes or beyond — before the target is decided. A negative scan is not a reason to skip salvage treatment. MRI helps define the urethro-vesical anastomosis, the CTV and any visible recurrence. The bed moves with bladder and rectal filling, so check the registration around the bed itself.
Daily imaging matched on soft tissue, surgical clips or bony anatomy, depending on department policy.
There are no fiducials in a prostate that is no longer there. Clips can help but may not move with the bed; soft-tissue matching on the bladder and rectum is often used alongside them.
Consensus atlases define the prostate bed; margins and nodal decisions come from your protocol.
The region of the former prostate and seminal vesicles, including the vesicourethral anastomosis, defined by anatomical boundaries.
Because the target is not visible, contouring consistency depends on following a consensus atlas. The RTOG consensus guideline is the common starting point.
Pelvic lymph node regions, treated in some salvage situations.
Some protocols include schedules that treat pelvic nodes alongside the bed, which brings small bowel into consideration.
An expansion for setup and motion uncertainty.
The bed moves with bladder and rectal filling, and there is no internal marker to follow it directly, which shapes how margins are chosen.
Click an organ for its anatomy, why it matters and contouring resources. Superscripts link to the study behind each value.
| Organ | 64–66 Gy / 32–33 fx2 Gy per fraction | 52.5 Gy / 20 fx2.63 Gy per fraction |
|---|---|---|
| Rectum | ||
| Bladder | ||
| Femoral Heads |
|
|
| Small Bowel |
|
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| Large Bowel / SigmoidGeneral conventional limits, not prostate-specific. | — |
Values quoted from eviQ 4487 (first approved 7 November 2024; review due 31 December 2026) and CORSAIR, checked by DoseLab on 2026-09-22. Verify against your protocol, institutional policy and physician directive before clinical use.
Randomized phase 3 trial comparing adjuvant with early salvage radiotherapy after radical prostatectomy. Citation as given in the eviQ reference list; not yet checked against the journal.
Randomized phase 3 trial of adjuvant versus observation with early salvage radiotherapy after radical prostatectomy. Citation as given in the eviQ reference list; not yet checked against the journal.
Randomized trial of androgen deprivation duration with postoperative radiotherapy. Citation as given in the eviQ reference list; not yet checked against the journal.
RTOG consensus guidelines for the post-prostatectomy clinical target volume.
RTOG consensus panel atlas of male and female pelvic normal tissues. Citation as given in the eviQ reference list; not yet checked against the journal.
Phase 3 ANZUP trial protocol. Citation as given in the eviQ reference list; eviQ gives no further publication details, so the link is a search.
A 2010 journal supplement summarizing dose-volume and outcome data for normal tissues, organized by organ.