Tilki D, Chen MH, Wu J, et al. - Randomized controlled trials did not describe reduced progression-free survival in correlation with adjuvant vs early salvage radiation therapy (sRT) following radical prostatectomy (RP). Considering that these trials might have missed a benefit in men with adverse pathology at RP as these men were under-represented and immortal time bias might have been present, researchers sought to investigate this possibility. The impact of adjuvant vs early sRT on all-cause mortality (ACM) risk was evaluated in men with adverse pathology, which was defined as positive pelvic lymph nodes (pN1) or pGleason score 8-10 prostate cancer (PC) and disease extending beyond the prostate (pT3/4). After excluding men with a persistent prostate-specific antigen, a significantly lower ACM risk was recorded in correlation with receiving adjuvant vs early sRT among men with adverse pathology at RP when men with pN1 PC were excluded. Based on findings, they recommend considering adjuvant radiation therapy in men with pN1 or pGleason score 8 to 10 and pT3/4 PC given the possibility that a significant reduction in ACM risk exists.