Extending Survival with Radiation after Prostate Cancer Surgery

The surprising fact to most men who undergo surgery for prostate cancer is that about 25% need radiation even after surgery.  But who should undergo radiation?  And when?

A recent report from the 2016 Genitourinary Cancer Symposium sheds some light on the issue.  Dr. Danielle Rodin and co-workers looked at the clinical records of 388 men at the Massachusetts General Hospital who underwent prostate cancer surgery followed by radiation because of a rising PSA level months to years after their surgery.  Of those 388 men who had

PSA needs to be followed after surgery. Salvage radiation is often necessary.

PSA needs to be followed after surgery. Salvage radiation is often necessary.

salvage radiation, only 4 died from prostate cancer.  The Massachusetts General Hospital findings confirmed the risk factors for a rising PSA after surgery-a higher Gleason score, cancer invasion through the capsule, and invasion into the seminal vesicles found at time of surgery. 

But the new finding from Dr. Rodin’s study centers on the importance of PSA doubling time.  Dr. Rodin commented “We found that when the PSA level was less than 1 ng/ML, PSA doubling time was actually a more significant predictor of disease progression than the actual PSA level itself.”  

The absolute PSA level does not have to be very high before radiation is recommended by most prostate cancer specialists.  When the PSA has reached a threshold of only 0.3 ng/ML, each further increase of 0.1 ng/ML resulted in higher rates of prostate cancer progression.  Dr. Rodin went on to comment that “When you are looking at a patient and evaluating all the risk factors, if you see a rapid doubling time in a patient with a very low PSA, I think that would support starting salvage radiation therapy.” 

So What’s A Prostate Cancer Patient To Do? 

I strongly believe that prostate cancer patients who have surgery need to be proactive.  I think that they need to ask their urologist exactly what was found at surgery.  Was their cancer worse than what was thought prior to surgery?  Did the Gleason score go up as compared to the biopsy before surgery?  Did their prostate cancer go through the capsule or into the seminal vesicles?

And remember the importance of PSA doubling time-even a score of only 0.3 ng/ML that doubles to 0.6 ng/ML in less than 12 months is reason enough to start radiation therapy.  And do ask your urologist to actually calculate your own PSA doubling time.  Your health and quality of life may well depend upon it. 

If you have any questions about your prostate cancer, please feel free to call me, Dr. Edward Hughes, at 855-DAYTON1.