Radical prostatectomy (RP) has been found to be curative in most cases of prostate cancer (PCa); however, 20-40% of patients have a biochemical recurrence (BCR) of the disease. Prostatic specific antigen prostate-specific antigen (PSA) levels are used to assess patient prognosis after surgery; however, there is no consensus about the optimal PSA level that defines BCR. Detection of very low volume disease and early detection of the disease are very important predictors for clinical outcomes in BCR, as early salvage radiation therapy (SRT) provides a possibility of a cure. The aim of this study is to review briefly about important and controversies in radiotherapy after radical prostatectomy. No guideline exists to select ideal patients for each treatment, but there are tools currently being developed; genetic tests and prostate-specific membrane antigen (PSMA) positron emission tomography (PET) may be able to identify patients with worse outcomes who would benefit from more treatment.
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