Can radiation therapy combat a rising PSA after surgery?

Nancy Ferrari

Senior editor, Harvard Health

I had a radical prostatectomy a year ago and thought I was cured. But now my PSA is rising rapidly, making me think I have an aggressive form of prostate cancer. Is there any reason to believe that radiation therapy might help?

Carolyn Lamb, M.D., a radiation oncologist at Mount Auburn Hospital in Cambridge, Massachusetts, says:

Unfortunately, 15% to 40% of patients who undergo a radical prostatectomy experience a setback like yours within five years. Most men who find themselves in this situation have more questions than answers: Should I start salvage therapy right away or wait until I have signs of metastatic disease? If I opt for salvage therapy, should I choose radiation therapy, hormones, or a combination of the two? And no matter which way you go, there are trade-offs. Your PSA may improve, but side effects may worsen your quality of life.

A recent study may offer some guidance. Researchers at Johns Hopkins Hospital followed 635 men whose disease recurred after a radical prostatectomy. Of that number, 397 men opted for no treatment, 160 received salvage radiation therapy, and 78 combined salvage radiation therapy and hormones. The researchers found that the men who received no treatment were twice as likely to die from prostate cancer over the next six years, on average, as those who had radiation.

Physicians have believed that men like you with rapidly rising PSA scores were unlikely to benefit from radiation therapy because the cancer had probably already spread out of the local area. This study contradicts the conventional thinking: researchers found that the survival benefit was greatest for men with aggressive cancers. Among the 166 men with a PSA doubling time of less than six months, those who had radiation alone or combined with hormone therapy were 75% less likely to die of prostate cancer than men who opted for no treatment. Those who did the best started radiation within two years and when their PSA was 2 ng/ml or lower.

Admittedly, men in this study weren’t randomly assigned to receive one treatment or the other. But the findings offer some evidence that radiation therapy can extend survival. (However, having radiation therapy after a radical prostatectomy may increase the risk of complications, such as impotence and urinary incontinence.) Talk to a radiation oncologist about developing a treatment plan to meet your needs.

SOURCE: Trock BJ, Han M, Freedland SJ, et al. Prostate Cancer-Specific Survival Following Salvage Radiotherapy vs. Observation in Men with Biochemical Recurrence after Radical Prostatectomy. Journal of the American Medical Association 2008;299:2760–69. PMID: 18560003.

Originally published Oct. 1, 2008; last reviewed April 8, 2011

Comments:

  1. Stephen Matz

    I had proton radiation treatments for prostate cancer at MD Anderson in February-March 2010. In 2015 the prostate cancer returned and was still contained within the prostate. In August of 2015 I had a robotic radical prostatectomy. The surgeon said he was unable to remove all of the prostate as it had adhered to the colon/rectum.
    We have been watching my psa since December 2015 when it was .09. It has steadily risen to .57 in June 2018. My doctor has said don’t worry until it reaches 4.0 which won’t happen for about five more years. I am currently 70 years young and had a brother that died of colon cancer at the age of 67. Is there a possibility that cancer could move to the colon or rectum in these next 5 years? If so, what treatment would or could I have before then? Is a psa of 4.0 really a good number to wait for? My psa in 2010 was 4.0 when the cancer was discovered with 5 of 12 biopsies cancerous and 2 pre-cancerous.

  2. Tom from Kissimmee, FL.

    I had robotic radical prostatectomy on June 16th, 2016. Immediately after surgery, I had a psa of 0.3 My surgeon said it may not mean anything and that I was to get a new psa in 6 weeks and come back to see him at that time.
    It had fallen to 0.2, but he said not good enough. I had another psa in 6 weeks and it spiked to 0.4. At this point, he advised that I needed several radiation treatments, 39 to be exact, over 6 to 7 weeks. After all that, I still had a 0.4 psa. This is now about 10 months post surgery. Waited 4 weeks and had another psa. It was now at 0.5. I was told that I should get an injection of luperin, a hormone blend of some kind. After some administrative snafus by the doctor’s office and insurance co, I was finally given the injection by my urologist on July 23rd, 2017. A few weeks later I went for another psa and finally it was less than 0.1. In October, 2017 at my Oncologist appointment, she was very pleased and said come back in 6 months. I had a psa test on April 5th.
    In my next oncologist visit on 04/18/18, I was told it was still less than 0.1. My next follow-up is October
    21st of this year.
    Seems that Luperin was the magic elixir and I can only conclude that the radiation was of little use, if any, for me. It has also left me with a lot of annoying side effects, which are too extensive to go into now. I should have been told of the Luperin at the beginning of my post op treatment.
    However, the one downside for Luperin is the cost. In July of 2017, the cost for one injection was $4800. I had a copay of $825. For some people, the cost can be prohibitive.
    I haven’t done the calculations, but I would venture that the radiation treatments were a lot more costly and inconvenient too.

  3. Christopher Jennings

    Had R.P in July 2016. PSA undetectable for 18 months then rose to 0.1 in Feb 2018 . Now at 0.27 in June and am scheduled for radiation salvage therapy now . Already lost 2 brothers to this , both in there late 70’s, and have just now turned 70 myself .I have to confess to disappointment at , and lack of sufficient information from cancer care professionals , who need to be more forthcoming to there patients. Most of the relevant information that I needed , I obtained myself from internet sources such as this . Lesson is that you have to be on top of your own diagnosis if you need to understand what is happening to you . Please wish me luck with the radiation .

  4. John Preston

    John Preston
    Same story, my PSA levels went from1.0 to over 7 in 6 months. I had robotic surgery at SLU by a DR I trust very much in April 2017. My PSA has climbed to .37, and now I’m scheduled for
    A course of radiation treatment. My wife and I are optimistic about my results. My suggestion to anyone reading this is if you are not getting the answers you need from your DR, you need to find a different DR. My wife and I fired my first DR because his staff kept missing key factors in my diagnosis. We researched Dr’s in the state of Missouri that specializes in this surgery and found my current DR. Good luck to all of you, there is hope!

  5. Jacqueline Z Massey

    My husband had total robotic prostate removal 1/1818. We just went for 1st follow up after 3 months and his PSA came back 1.8. We are both very upset and scared. What happens next?

  6. LauraLeah

    My husband (age 45) had robotic prostatectomy in June 2016. His PSA did go to 0.0, but in Sept. 2017 it went to .1 Doc told us not to be too concerned and to come back in Feb. where it was .2 Now, a month later it is .3 He isn’t reading much information about it, but I am freaking out. His father died of PC five years ago. Any advice would be dearly appreciated.

  7. LauraLeah

    David Brooks – please seek a second opinion. Your doctor should not postpone your consult three months. Where do you live? I would seek out the best of the best in your area.

  8. David Brooks

    I had radical surgery Aug17. 8 weeks later PSA reading 0.24. 33 radiotherapy treatments Dec 17 through to Jan 18. 6 weeks later PSA reading of 0.18. My doctor is never available to speak to but have postponed consultation March 18 to June 18. I am not sure whether I still have cancer and is would another CT scan be worthwhile. Can anybody advise please

  9. Tim Z

    Had robotic prostatectomy 5/1 and my PSA came back 2.0 in August. Still confused and multiple doctors give me conflicting advise on what to do. Ugh.

  10. Maria Care

    I did my surgery with Dr Finkelstein at surgical operations

  11. Ronnie Austin

    I had prostate surgery 2 yrs ago my PSA stayed .1 for a year to .3 after 2 yrs I just finish 8 weeks of radiation therapy with Harmon treatment so Whts nxt for me wht should I expect my follow up is Dec 4

  12. Esther O'Donnell

    Hello Nathan and Jonathan,

    My husband had radical prostatectomy surgery on 8/19/2016 and on 09/09/2016 his PSA was .34 and then 12/12/2016 his PSA was .39

    He is scheduled to go back on March 6 2017 for a bone scan and another PSA test. The reason we are waiting till March for the next test is the doctor has said that even if something was positive with the tests, he is still healing/recovering from surgery would not be able to start any treatment before March.

    As Jonathan suggested above, my husband is being careful with his diet and exercises regularly. We have also been investigating CBD (Cannabidiol—CBD—is a cannabis compound that is said to have significant medical benefits, but does not make people feel “stoned” ). Have either of you heard about this? We have not spoken to his doctor about it yet.

    Jonathan-I hope you are doing well with the chemo and radiotherapy. Is there any insight that you can share with us? …it would be greatly appreciated.

    Nathan- Have you decided on a treatment yet?

    Hope you both are doing well.

    Thank you,
    Esther

  13. Jonathan Burnham

    Hi Nathan
    Similar to You I had op in November 2015 and by February 2016 PSA of 0.3
    It was found that cancer had spread to seminal duct and glands.Have just completed a 30 day course of “chemo” tablets and am now waiting to start 8 weeks radiotherapy.
    According to my consultant the only way you can have a SPA count above zero is that the disease has spread elsewhere.

    Am sure your condition will be monitored by your medics and my “layman’s opinion” is to take the necessary treatment they advise as soon as possible.

    Be careful in your diet, exercise and sleep patterns (you will sleep) and all will be well. Good luck my friend.

  14. Nathan

    I just had radical prostate surgery 01/12/16 It’s now 02/11 /16 my PSA came back .3 !! The cancer was confine to the prostate. how can I have a PSA score so high right after surgery .

  15. anup shah

    my father was detected with prostate cancer in 2002 the surgery was successful . now after twelve years again the psa level is rising and the cells have spread in the bones to 70%. what i wanted to know is that what can be the side effects or result if the psa level keeps on rising ? please revert to me

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