Radiation after Robotic or Open Radical Prostatectomy

Hi Everyone,

I was talking to someone in my office who had an open Radical Prostatectomy 5 years ago and his surgeon immediately followed the surgery with radiation for 2 or 3 weeks just to be on the safe side in killing any residual cancer cells.

He said he did not have any positive margins at the time of surgery.

Is that a standard protocol today??  Are there any studies that the radiation right after surgery helps in preventing PSA levels from rising in the future?  I assume the radiation levels would be a great deal less intensive than having radiation as your primary treatment.

Wouldn't you have to have a radiologist working with your surgeon to coordinate such efforts. 

Just curious about the pro's and con's of having both treatments so close together even before the initial PSA read.

Thanks In Advance 

Do you have Patrick Walsh's book on Surviving Prostate cancer? I believe studies at John Hopkins has shown no difference in starting radiation immediately or waiting to see what happens. I took the wait and see as you know.

lewvino

I believe studies at John Hopkins has shown no difference in starting radiation immediately or waiting to see what happens.

i'm sure that depends on when the adjuvant/salvage treatment is administered.  obviously SRT at PSA .1 has a better chance of being effective then at PSA .5. which in my mind gives adjuvant treatment an advantage.

ed

 

Thanks for the Input.

I did not have all his stats except he said he had no positive margins but he was treated at Emory Univ in Atlanta where he probably had a radiologist and urologist working together on his case. 

He just told me to ask about it when I go to Vanderbilt for Robotic Surgery next month to get a feel for when such treatment is warranted at such an early stage after surgery. 

Thanks Again

 

What makes this confusing is that not only do different doctors say different things, but the same doctors will say different things depending who they are talking to. I am sure that if my post-op pathology report had confirmed my biopsy-reported diagnosis, as a very low volume Gleason 7(3+4), then my surgeon would have been all about waiting to see what my PSA did before pulling the trigger on radiation. But when I came back as a high volume Gleason 9 with positive margins I was shuttled off to a MO and an RO post-haste to get set for radiation and nobody cared a lick what my PSA did.

If you are a Gleason 6 there is no reason for your doctor to complicate his story telling you the rules that would apply if you had an entirely different cancer. Waiting for a confirmed PSA rise to 0.2 makes perfect sense for low-risk cancer after surgery. Adjuvant treatments for high-risk disease is a completely different kettle of fish.

Thanks for the Info.  I had not talked to Dr Smith about this but glad you filled me in.

Thanks Again

Going through IMRT (Treatment #6 yesterday) and had Dr. Smith for my surgery 4 years ago. A short time following surgery I was informed of my positive margin.

I see a local urologist and my oncologist told me she had been in contact with Dr. Smith about my particulars. At year 3 I tested as .2. Second test three months later was still .2 Next test six months later was .3 and then I was recommended to start the IMRT.

So that falls right in line with several of the above comments.

lewvino

In my opinion, and that of several doctors I consulted before treatment, if you expect radiation after surgery, why do surgery in the first place? This only increases risk and multiplies side effects. You can use brachytherapy rather than the surgery with the same or better cancer control and less side effects.

I strongly advise you to do everything possible to accurately determine the probability of hving radiation before you commit to surgery.