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Wednesday, June 29, 2016
What to do after Prostate Cancer Surgery
Hello, I have a couple of questions. My cousin recently had Robotic surgery to remove his prostate. His gleason score was 4+5 = 9 but the cancer had not spread to his lymph nodes or seminal vesicles. It was just outside the prostate gland on surrounding tissue. He is debating whether he should do radiation or not. The bowel, bladder and impotence effects of radiation are huge factors that he is trying to avoid, so he doesn`t want to do radiation if it`s not necessary. Do you think he should go through with the radiation? If so, what type? He is 59 years old and in good health. He had a very active sexual life prior to surgery so he would like to find what what his odds are of the radiation side effects.
Also, he had the surgery one month ago and recently had two PSA tests conducted: Regular PSA and Super PSA. The scores were as follows: Regular PSA: Less than 0.1 Super PSA: 0.016 Are those good scores?
Please advise. Thank you!
As per the information provided, your cousin seems to have a high grade cancer (Gleeson 9) which is locally advanced (outside the prostate gland). These factors do point to the possibility of higher risk of recurrence. There have been a few recent studies in medical literature demonstrating decreased rates of biochemical recurrence (detected by the PSA blood test) after radiation therapy after radical prostatectomy in men with locally advanced disease but sufficient data is not yet available to know whether this actually translated into longer overall survival of the patient. The fact that his PSA is less than 0.1 is a good finding. (I am not sure what you mean by super PSA).
As you are aware, the options in his situation would be either to monitor with regular PSa tests with further treatment /radiation if needed or proceed ahead with radiation therapy now itself. In a young healthy patient with higher risk disease as your cousin, it would not be unreasonable to proceed with adjuvant radiation therapy with the understanding that recent studies have shown some benefit of biochemical recurrence free survival without much available information about impact on the overall survival. (mentioned above).
Radiation therapy after radical prostatectomy seems to be reasonably well tolerated, though erectile dysfunction is a possibility (options available to manage this). He should discuss this in detail with a radiation therapist dealing with prostate cancer. It would be also useful to know whether there were any lymph nodes removed during the proistate surgery and whether these were involved /not involved by the cancer as involved lymph nodes would change the stage of the disease.
I have attempted to answer your questions based on the information in your mail and hope you find it useful. There are several options/opinions to treat prostate cancer, as I am sure you are aware, and I would suggest that your cousin have a detailed discussion/clinical assessment by his urologist, radiation therapist and even a medical oncologist before he makes his decision.
Krishnanath Gaitonde, MD
Assistant Professor of Clinical Urology
College of Medicine
University of Cincinnati