Radiation is a mainstay for salvage treatment after surgery and a salvage option for relapse after previous radiation. Radiation, when it is given preventatively, while the PSA is still undetectable, is called adjuvant therapy. Adjuvant radiotherapy can be considered for men after surgery who have extracapsular extension, seminal vesicle invasion, or positive margins. In one prospective study, adjuvant radiation improved the cure rate from 41 percent to 61 percent. In another study, the 10-year survival rate was improved from 66 percent to 74 percent.
Radiation delayed until PSA begins to rise is called salvage treatment. Salvage radiotherapy is given to patients whose PSA either fails to become undetectable after surgery, or if the PSA subsequently rises after being undetectable. Success rates are improved by using salvage radiation when the PSA is lower. The effectiveness of salvage radiation may be further improved with the addition of TIP in some patients.
What about Using TIP without Radiation?
In a study evaluating the 8-year cancer-specific survival rate with TIP alone, the rate with TIP alone was lower (86 percent) than what was achieved with the combination of TIP plus radiation (92 percent). In a different study, the results of a retrospective evaluation of 1,338 men with node metastases, the 10-year mortality rate was reduced by as much as 40 percent in the men who received radiation and TIP compared to TIP alone.
Radiotherapy Side Effects
A good urinary outcome depends on delaying radiation until full urinary recovery has been achieved after surgery. Patients who are incontinent at the time of radiation usually will remain so. Regarding erectile function, delaying radiation as long as possible improves the odds of preserving it.
ABOUT THE AUTHOR
Christopher Rose, MD is a board-certified radiation oncologist. He received his bachelor’s degree from the Massachusetts Institute of Technology and his doctorate from Harvard Medical School. His residency in radiation oncology was at the Harvard Joint Center for Radiation Therapy. Dr. Rose was a visiting clinical scientist at the Institute for Cancer Research, Royal Marsden Hospital, University of London, in Great Britain. He was an assistant professor of radiation oncology at Harvard Medical School. He also served as chairman of the Board of Directors and president of the American Society of Therapeutic Radiology and Oncology. He is past president of the Council of Affiliated Regional Radiation Oncology Societies of the American College of Radiology, past president of the California Radiation Oncology Society, and counselor of the American College of Radiology. He is currently a member of the Medicare Coverage Advisory Commission and vice chair of the NCI-sponsored Quality Research in Radiation Oncology Study. Dr. Rose has published more than 50 peer-reviewed articles. He received the Donald Coffey Clinician Scientist Award from the PCF. He is the 2008 gold medalist of the American Society of Therapeutic Radiology and Oncology.