What is the success of radiation after radical prostatectomy failure?

Question: I'm a 60-year-old man who had a radical prostatectomy 3 years ago; my PSA continues to rise slowly. It went above 0.2 about 2 years ago. It is now 0.75. How successful is salvage radiation therapy after radical prostatectomy failure?

Answer: This really depends upon the individual's original tumor characteristics. Generally, about 80 percent of the men who receive this treatment will see their PSA decrease, with most of them falling to undetectable levels. However, men with advanced disease at the time of a radical prostatectomy are less likely to have a PSA response.

When should salvage radiation be administered?

Question: I'm a 60-year-old man who had a radical prostatectomy 3 years ago, and my PSA continues to rise slowly. It went above 0.2 about 2 years ago. It is now 0.75. How successful is salvage radiation therapy after radical prostatectomy failure? At what PSA level should salvage radiation be given?

Answer: There is no definitive answer to this question; however, there are overall better results if radiation therapy begins before the PSA reaches 2.5. A number of other studies suggest it should be given before the PSA reaches 1.0. At 5 years, a few studies show that up to 50 percent of men have very low PSAs that are not increasing.

When should salvage radiation be administered?

Question: Will salvage radiation work if I had a radical prostatectomy 1 year ago, but my PSA, which began at 15, only went down to 3.5 three months after my surgery?

Answer: Generally, PSAs that do not go down to less than 0.4 after radical prostatectomy indicate either residual local disease and/or systemic microscopic (metastatic) disease. Your doctor will be able to better assess which category you are in based upon the pathology report from your radical prostatectomy and the rate of rise of your PSA.

Are there side effects to radiation after a radical prostatectomy?

Question: I was told by my urologist to go for radiation treatments to the prostatic fossa (cavity) after failing a radical prostatectomy. What are the side effects of postprostatectomy radiation therapy?

Answer: Incontinence usually occurs in less than 5 percent of patients. The increase over a radical prostatectomy alone for severe incontinence is less than 1 percent. Blood in the urine (usually temporary) is less than 5 percent. Major rectal bleeding (usually temporary) is up to 6 percent, and bowel urgency and incontinence is less than 5 percent. An increase of impotence of about 30 percent occurs after radiation therapy compared with radical prostatectomy only.

What is adjuvant radiation therapy and when should it be used? 

Question: I'm a 55-year-old man who had a radical prostatectomy 3 weeks ago. My margins were positive in two places.

Answer: Adjuvant radiation therapy is radiation given to the area of the prostatic bed when there is evidence of margins showing cancer after a radical prostatectomy or if the PSA does not decrease to less than 0.2 nanograms per milliliter, and it is felt that this is most likely due to residual local disease.

What are the results of adjuvant radiation therapy after radical prostatectomy? 

Question: I'm a 55-year-old man who had a radical prostatectomy 3 weeks ago. My margins were positive in two places. My doctor recommended that I start radiation to the area where my prostate was in 1 to 2 weeks. Should I begin this treatment?

Answer: Preliminary results of two trials show that there is a reduction in the biochemical failure rate at 5 years if adjuvant radiation therapy is given. Adjuvant radiation therapy is preferable in younger men with long life expectancies.

Who is the ideal candidate for adjuvant radiation therapy? 

Question: I'm a 55-year-old man who had a radical prostatectomy 3 weeks ago. My margins were positive in two places. Should I have radiation to my prostatic fossa (cavity) now?

Answer: The ideal patient would have a positive radical prostatectomy margin, no seminal vesicle invasion, a PSA doubling time of greater than 10 months, a low preradiation therapy PSA (less than 1 nanogram per milliliter), and a radical prostatectomy Gleason score of less than 7.

What is the best treatment for a single area of pain caused by metastatic prostate cancer? 

Question: I have pain in my midback and have been told there is prostate cancer there. Although I have other areas of involvement on my bone scan and am on hormonal therapy, my doctor recommends I have radiation to the area of pain. What do you think?

Answer: Radiation therapy given to that area will usually significantly decrease pain in 80 percent of patients. It may also prevent a vertebral fracture and or spinal cord compression. Chemotherapy with Taxotere^® (docetaxel) can also decrease pain.

What is the best treatment for multiple symptomatic (two or more) areas of metastatic prostate cancer in bone?

Question: I'm 75 years old and have multiple painful areas despite hormonal therapy. Is there anything besides pain medication that I can do to get relief?

Answer: There are two radioactive isotopes—strontium and Quadramet^® (samarium)—that have been shown to be very effective in this setting. Samarium has less bone marrow toxicity and in my opinion is the treatment of choice. It can be used multiple times if necessary and works about 80 percent of the time for 3 to 6 months. Studies combining chemotherapy and isotope therapy are ongoing.

It can be used with other systemic therapy to help control tumor growth in other areas.

Is there a survival benefit associated with radioactive isotope treatment?

Question: My doctor sent me to a radiation oncologist for radioactive isotope treatment since I have three or four metastatic areas in my bones that are painful. Will this treatment improve my survival time?

Answer: Only palliation (lessening) of symptoms has been shown with the use of these agents alone. There is one study that shows a survival benefit when used with chemotherapy. This needs to be further tested. This approach is being confirmed in a national randomized trial.

What is the evidence that radiation therapy postoperatively after a radical prostatectomy is beneficial to patients?

Question: If I just had a radical prostatectomy and had disease involving the capsule, what is the evidence to support my receiving radiation therapy postoperatively?

Answer: Southwest Oncology Group (SWOG) trial 8794 enrolled 425 patients with pathologically determined extracapsular extension, positive margins, and/or seminal vesicle involvement. Patients received either observation or external beam radiation therapy. The patients who received radiation had about one-half the risk of PSA failure at 10 years compared with the observation group.