There are no standardised guidelines for the role of adjuvant radiotherapy post-prostatectomy. Evidence that may shed light into its appropriate usage is marred by the difficulty in defining adjuvant radiotherapy and failure of some studies to adequately distinguish it from salvage radiotherapy. The ability to identify which prostate cancers are likely to benefit from immediate post-operative radiotherapy would enable the judicious use of this modality and minimise the unnecessary exposure to its side-effects. This review outlines the pre- and post-surgical clinical considerations that form the discussion around the requirement for adjuvant therapy; radiotherapy, androgen deprivation therapy and chemotherapy. Principles for the use of local and systemic therapies are discussed.