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Recent Surgery now increased PSA

esheka
Posts: 2
Joined: Nov 2004

Hi everyone,

I have a loved one that recently went through a RP 5/11/11. Gleeson of 8 T2C with known unclean borders on one side. Recheck of PSA one month after surgery showed a PSA of 0.42. He will now be starting radiation therapy in July as soon as he is cleared from surgeon. My question is 1) I know that a PSA score of anything about "0" is not good, but please give me reality of how bad is it really when looking at re-occurance (and is it considered reoccurance is just continuation of disease since the PSA never got to "0"?) and if radiation will be effective. 2) What are the common side effects of radiation therapy with 38 treatments?

Thank you!

VascodaGama's picture
VascodaGama
Posts: 1567
Joined: Nov 2010

Esheka

It would help if you post here the pathological stage given to your loved one after surgery. The stage will show details of analysis done to the prostate gland under the microscope.
The PSA before surgery is also considered when diagnosing recurrence and it will help in the decision of a salvage treatment.

PSA=0.42 one month after surgery is indicative that the RP did not removed the cancer totally from his body and that metastases exist. PSA after surgery is expected to go down to levels below 0.06, which is considered by many doctors as “remission”.
Recurrence, however, is declared after verifying a constant increase of PSA. Doctors tend to get tests two or three months apart to verify and confirm recurrence, before committing to a salvage treatment.

Salvage radiotherapy (SRT) is standard for recurrence but radiation is applied to targeted areas where cancer exits. Radiation is not delivered as a “sweeping” modality, because it kills good cells too. The radiologist must have a field to radiate which will be based on image studies or protocols fixed on the data I commented above.

If your loved one is found with distant metastasis then radiation will not cure him. Hormonal treatment is required to care for those systemic cases. In this case a combination of SRT plus HT may be advisable. In some cases HT is used alone or as neoadjuvant.

In my case of SRT I had 37 fractions of 2.0Gys. A number of 36 to 40 fractions are common but the total Gys is more important. (ex: 38 x 2.0 = 76 Gys). Nowadays it is common to see treatments of higher dosage closer to 80 Gys because it presents better successful rates. Low doses do not cure but control part of the problem. However, decision for RT is also dependent of other concerns such as age, the existence of colitis history or any other health problem indirect to PCa.

Your lovely one may be experiencing some side effects from RP to which SRT will add more. I recommend you to read about details in these sites;
http://www.cancercompass.com/prostate-cancer-information/side-effects.htm
http://www.prostate-cancer.com/radiation/side-effects/radiation-side-effects.html

Hope this post is of help to you.
Wishing the best to your friend.

VGama

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