Prostate cancer is one of the most common cancers in men. Treatment options vary based on the stage of the cancer and the patient’s overall health, but one common treatment for localized prostate cancer is surgery to remove the prostate (radical prostatectomy).
Even after a successful surgery, some cancer cells may remain. Radiation therapy can be used to eliminate any remaining cancer cells. Doctors may use adjuvant radiation therapy, which means radiation when there’s a high risk of recurrence even if tests don’t detect cancer. Or they may use salvage radiation therapy if tests indicate that the cancer has returned.
Many factors go into deciding how many radiation treatments are needed for prostate cancer after surgery. In this article, we’ll explore some of those considerations.
Understanding Adjuvant Radiation Therapy
After surgery for prostate cancer, doctors sometimes recommend adjuvant radiation therapy to eliminate any lingering cancer cells. This is extra insurance, so to speak, against recurrence.
Indications for Adjuvant Radiation Therapy
Adjuvant radiation therapy is typically recommended when certain high-risk features are discovered during the pathological examination of the removed prostate tissue. These features suggest a higher likelihood of cancer recurrence and include:
- Positive surgical margins: Cancer cells found at the edge of the removed tissue.
- Seminal vesicle invasion: The cancer has spread beyond the prostate gland to the seminal vesicles.
- Extraprostatic extension: The cancer has grown outside the prostate gland.
Timing and Dosage of Adjuvant Radiation Therapy
If adjuvant radiation is recommended, the typical timeframe is within a few months after surgery. This allows the surgical site to heal while still targeting any remaining cancer cells before they have a chance to grow.
The standard radiation dose generally ranges from 64-70 Gray (Gy). This total dose is divided into smaller, daily fractions delivered over several weeks. This approach, called standard fractionation, uses smaller daily doses over a longer period.
Another approach, hypofractionation, involves larger daily doses over a shorter period. Hypofractionation is gaining acceptance in some cases, offering convenience for patients. Your doctor will determine the best approach for your specific situation.
Understanding Salvage Radiation Therapy
So, how many radiation treatments will you need after prostate surgery? That depends on whether you’re receiving adjuvant or salvage radiation therapy.
Let’s take a closer look at salvage radiation therapy, which is used when prostate cancer comes back.
When is Salvage Radiation Therapy Recommended?
Salvage radiation therapy is typically recommended in the following situations:
- Rising PSA levels: If your PSA levels start to rise after a radical prostatectomy, it could indicate that the cancer has returned. This is known as biochemical recurrence.
- PSA level threshold: Doctors usually consider salvage radiation when the PSA level reaches or exceeds 0.2 ng/mL.
- Early intervention: Starting salvage radiation early, when PSA levels are still low, is often linked to better results.
Timing and Dosage
- Optimal timing: It’s best to start salvage radiation as soon as PSA recurrence is confirmed to maximize its effectiveness.
- Standard radiation dose: The radiation dose for salvage therapy is usually around 64-70 Gy, similar to adjuvant therapy.
- The role of imaging: PSMA PET/CT scans can help pinpoint the location of the recurrence, which helps with planning the radiation therapy.
Factors Influencing the Number of Radiation Treatments
The number of radiation treatments needed after prostate cancer surgery isn’t a one-size-fits-all answer. Several factors come into play, and doctors carefully weigh these to create a personalized treatment plan.
Patient-Specific Factors
- Overall health and life expectancy: A patient’s general health and how long they are expected to live heavily influence treatment decisions. Someone in excellent health might be able to tolerate a more aggressive approach.
- Tolerance to side effects: Radiation can have side effects, and a patient’s ability to handle these is a key consideration. Doctors want to balance effectiveness with quality of life.
- Patient preference: Ultimately, the patient’s values and preferences should be part of the decision-making process. It’s a collaborative effort between doctor and patient.
Disease-Related Factors
- Extent of disease: Is the recurrence localized to a small area, or is it more widespread? This significantly impacts the radiation strategy.
- PSA doubling time: PSA (prostate-specific antigen) doubling time is a measure of how quickly the cancer is growing. A shorter doubling time suggests a more aggressive recurrence that may require more intensive treatment.
- Gleason score of the original tumor: The Gleason score, which indicates how aggressive the original cancer cells were, provides valuable information about the cancer’s potential behavior.
Treatment-Related Factors
- Radiation technique: Different radiation techniques, like Intensity-Modulated Radiation Therapy (IMRT), Volumetric Modulated Arc Therapy (VMAT), Stereotactic Body Radiotherapy (SBRT), and CyberKnife, allow for more precise targeting of the cancer and can influence the number of treatments needed.
- Use of hormone therapy: Hormone therapy, also known as androgen deprivation therapy (ADT), is often combined with radiation to make it more effective. This combination can sometimes influence the radiation dosage and frequency.
- Prior treatments: The type of surgery performed and whether lymph nodes were removed can affect how radiation is planned and delivered.
Potential Side Effects and Management
Like any cancer treatment, radiation therapy after prostate surgery comes with potential side effects. It’s important to discuss these with your doctor so you know what to expect and how to manage them.
Acute Side Effects: These are side effects that occur during or shortly after treatment. Common ones include:
- Fatigue
- Increased urinary frequency and urgency
- Bowel changes, such as diarrhea or loose stools
Late Side Effects: These are side effects that can develop months or even years after radiation therapy. They may include:
- Urinary incontinence
- Erectile dysfunction
- Rectal complications, such as bleeding or discomfort
Fortunately, many side effects can be managed effectively. Your doctor may recommend medications, lifestyle changes, or pelvic floor exercises to help you cope. Regular follow-up appointments and PSA (prostate-specific antigen) monitoring are crucial for detecting and managing any recurrence and for long-term management of side effects.
Frequently Asked Questions
Can you live 20 years after prostate removal?
Absolutely. Many men live long and healthy lives after prostate removal (radical prostatectomy). Survival rates depend on various factors, including the stage and grade of the cancer, the man’s overall health, and the effectiveness of treatment. It’s best to discuss your individual prognosis with your doctor.
What is the average PSA for a 70 year old?
PSA levels tend to increase with age, even in men without prostate cancer. While there’s no single “average,” a PSA level up to 4.0 ng/mL has traditionally been considered within the normal range. However, doctors often consider age-specific ranges and other risk factors when interpreting PSA results. Talk to your doctor about what’s normal for you.
What is the best drink to lower PSA?
Unfortunately, there’s no magic drink that will drastically lower your PSA. Some studies suggest that green tea and pomegranate juice may have a positive effect on prostate health, but more research is needed. Maintaining a healthy diet and lifestyle is always a good idea.
What should PSA be 2 years after radiation?
After radiation therapy for prostate cancer, the goal is for PSA levels to be very low or undetectable. The exact target PSA level will vary depending on the type of radiation used and the individual’s specific case. Your doctor will monitor your PSA levels closely and discuss what the target range is for you.
Can you treat prostate cancer with radiation twice?
Yes, it may be possible to treat prostate cancer with radiation more than once, but it depends on the specific circumstances. If the cancer recurs after initial radiation therapy, different types of radiation or other treatments, like surgery or hormone therapy, might be considered. Your doctor can determine the best course of action.
Closing Thoughts
The number of radiation treatments someone needs after prostate surgery depends on a lot of things. These include what the pathology report reveals after surgery, what the PSA levels are, and factors specific to the individual.
Because there are so many factors, it’s important to develop a treatment plan that’s designed just for you. This is the best way to improve your outcome and reduce any side effects.
The best approach involves a team of specialists, including surgeons and radiation oncologists. When you have the benefit of all these specialists working together, you can be confident that you’re getting the very best care.