Radiation therapy for persons who have elevated prostate-specific antigen (PSA) levels after surgery appears, in many cases, to result in the suppression of PSA levels for 5 or more years. This finding, from researchers in Minnesota, is important because an elevated PSA level is 1 of the most important indications that previous treatment may not have succeeded entirely and more treatment is needed.
Cancer of the prostate, a male sex gland located near the bladder and rectum, is a type of cancer that occurs commonly in older men. One test that may be performed to help indicate whether prostate cancer is suspected is a blood test for PSA, a protein produced by the prostate cells. If PSA levels are high, prostate cancer is more likely, and further tests are needed for diagnosis. Once prostate cancer is diagnosed, doctors must determine the stage (the extent of disease at diagnosis) and grade (how quickly the cancer is likely to grow) of the cancer. Doctors often use a system called the Gleason score to indicate the grade of disease, with a higher score indicating the likelihood of faster growth.
Treatment for prostate cancer depends on the stage and grade of disease, and preference of the patient. Treatment approaches may include delaying treatment until the cancer progresses, or surgery, radiation therapy, brachytherapy (use of radiation placed in the prostate), hormone therapy, chemotherapy, and/or biologic therapy to help the immune system fight the cancer. A radical prostatectomy is a surgical procedure to remove the prostate gland and some of the surrounding tissue, for persons in whom prostate cancer is localized, or has not spread outside the prostate gland. A pelvic lymph node dissection, meaning the removal of the lymph nodes around the prostate, may be done before the radical prostatectomy to determine whether these lymph nodes contain cancer cells. After a successful radical prostatectomy, PSA levels should be undetectable. If the PSA levels begin to increase, this indicates that the surgery may not have been completely successful and more therapy is needed to control the disease. There is some controversy about whether persons who have an elevated PSA after a prostatectomy should receive additional treatment immediately or whether it is more appropriate to wait until signs and symptoms of the cancer become evident.
One hundred sixty-six men underwent a radical prostatectomy for prostate cancer at the Mayo Clinic, and had subsequent elevation of PSA levels. Researchers treated these men with radiation therapy. The radiation therapy appeared to suppress the PSA levels, and after 52 months, 46% of patients had undetectable PSA levels. Patients who experienced a recurrence of the elevated PSA levels were most likely to be those with a higher stage and higher grade of disease. The side effects of the radiation therapy were few and limited.
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The researchers concluded that radiation therapy can be safely administered to men following a radical prostatectomy, with modest long-term side effects. Persons who have elevated PSA levels after surgery may wish to talk with their doctor about receiving radiation therapy or other treatment or of participating in a clinical trial in which other new therapies are being studied. Two sources of information on ongoing clinical trials that can be discussed with a doctor include a comprehensive, easy-to-use service provided by the National Cancer Institute (cancer.gov) and the Clinical Trials section and service offered by Cancer Consultants.com (www.411cancer.com). (The Journal of Urology, Vol 163, no 3, pp 845-850, 2000)
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