Radiation After Prostatectomy: More Common Than You Think

Rising PSA after prostatectomy means trouble.

A rising PSA level after prostatectomy, even robotic surgery, is more common the most men think. In fact, each year over 20,000 American men need so-called “salvage” radiation therapy in an attempt to cure men with prostate cancer who have a “biochemical failure” or an increasing PSA level after surgery. 

A number of clinical trials have shown that “salvage” radiation  therapy reduces PSA levels and also spread to lymph nodes and bone. Radiation should be done after surgery for prostate cancers as soon as the PSA levels start to rise.

In the landmark Mayo Clinic study of 1,427 men whose prostate surgery failed, showed that each doubling of the PSA after surgery increased the cancer-specific death by 40% (Stish BJ et al. J Clin Oncol  2016; August 1). These men had surgery alone and it was not successful. As their PSA levels continued to rise, so did their death rate.

So what this is mean for men whose PSA levels start to climb after prostate cancer surgery?  I believe that the Mayo Clinic results speak for themselves and are clear-cut. “Salvage” radiation therapy should be started as soon as possible after the PSA reaches 0.4 ng/mL. If men wait for that PSA to double once more, their chance of dying from prostate cancer increases by 40%. 

If you have any questions about your prostate cancer, please feel free to call me, Dr. Edward Hughes, at 855-Dayton 1.