Recently, investigators at Johns Hopkins studied 51 radical prostatectomy patients who experienced a rise in PSA after surgery. These men were followed until the location of the recurrent cancer could be identified; 30 percent of these men developed palpable local recurrence of cancer that was confirmed by biopsy; 70 percent showed signs of distant metastases with positive bone scans.
In this study, distant metastases were present in nearly all men who had early elevations of PSA during the first year after radical prostatectomy, men whose tumors had a high Gleason score (8 or higher), and men with cancer in the seminal vesicles or lymph nodes. Therefore, radiation therapy to the prostate bed (the area where the prostate used to be) probably isn’t going to get all the cancer in these men.
However, men in this study who had a late rise in PSA, men with low-grade disease (Gleason 7 or lower), and men with cancer-free seminal vesicles and pelvic lymph nodes were more likely to have local recurrence of cancer— cancer that has not yet metastasized. These men, then, would be more likely to benefit from radiation therapy to the prostate bed.
Should a man have radiation therapy immediately after surgery? No. It should be delayed at least three months, to give the body a chance to heal— and particularly to give the urinary tract a chance to recover. Irradiating a tender, sewn-together urinary tract is not the best way to encourage this inflamed tissue to heal.
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