What adjuvant treatment would you offer a patient who underwent cystoprostatectomy for a muscle invasive bladder cancer and discovered to also have prostate cancer?

Complex case.

If they have an indication for prostate RT (major: positive LN, persistent PSA, +SVI, minor: + margins, +ECE), I would consider treating the prostate fossa +/- LNs.

As far as the bladder, we don't have the answer yet, but high-risk patients are being studied on the BART study from Tata...

Currently, the indications for adjuvant RT for bladder cancer would be pT3/4 tumor with positive margins and/or positive nodes, but the data supporting the use of RT in this setting are not high level. This situation may be complicated by possible indications for adjuvant chemotherapy and/or immunot...

Agreed these are tough cases. In general, I'd rely on the modern early salvage data to just watch if PSA <0.2 even if the initial surgical intent wasn't definitive prostatectomy for prostate cancer.

Caveats of the ARTISTIC trials being low rates of higher risk features (e.g. GS 8-10 and N+) so as D...