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According to a study published in the International Journal of Radiation Oncology, Biology, Physics, some prostate cancer patients who experience a prostate-specific antigen (PSA) increase after radical prostatectomy will have good outcomes after additional treatment with radiation alone. Others may benefit from a combination of radiation and hormonal therapies.

The prostate is a gland of the male reproductive system. It produces some of the fluid that transports sperm during ejaculation. After skin cancer, prostate cancer is the most common form of cancer diagnosed in men. Current treatment options include watchful waiting (delay of treatment until signs of cancer progression), surgery, chemotherapy, radiation, and/or hormonal therapy. When surgery is recommended as part of the treatment plan, the surgeon may remove the entire prostate and some of the tissue around it. This procedure is known as a radical prostatectomy. After surgery, the patient’s levels of PSA may be monitored; a rise in PSA suggests that the cancer may have recurred.

In order to evaluate treatment outcomes among men who have a PSA rise after radical prostatectomy, researchers in Texas evaluated 111 prostate cancer patients who were treated between 1990 and 2001. All the men were treated with radiation therapy after experiencing a PSA rise, and 59 of the 111 also received hormonal therapy. Among men treated with radiation therapy alone, response to treatment was best among those who had positive surgical margins (evidence that not all the cancer was removed by surgery) after their radical prostatectomy and lower PSA levels when radiation therapy was started. PSA level also predicted the success of radiation and hormonal therapy. Since patients with positive surgical margins and low PSA levels appear to fare well after radiation therapy alone, these patients may not require further treatment with hormonal therapy. Patients who are less likely to respond to treatment with radiation therapy alone may benefit from the addition of hormonal therapy.

The researchers conclude that among men with a post-surgery increase in PSA, those with positive surgical margins and low PSA before beginning radiation therapy may have good outcomes with radiation alone. Treating these men with radiation therapy alone would avoid the adverse effects of hormonal therapy. In contrast, other groups of patients may benefit from the combination of radiation therapy and hormonal therapy. Regardless of the type of treatment chosen, the researchers emphasize that treatment appears to have the best chance of success if given early, when PSA is still low.

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Reference: Cheung R, Kamat AM, de Crevoisier R et al. Outcome of salvage radiotherapy for biochemical failure after radical prostatectomy with or without hormonal therapy. International Journal of Radiation Oncology, Biology, Physics. 2005;63:134-140.