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Rapid PSA Rise Calls for Radiation

"Salvage Radiotherapy" Boosts Survival After Prostate Cancer Surgery
WebMD Health News
Reviewed by Louise Chang, MD

Feb. 12, 2008 -- For the first time, researchers have shown that radiation can increase the odds of survival for men whose PSA levels rapidly rise after surgery for prostate cancer.

Johns Hopkins researchers reviewed data on more than 600 men with rising PSA levels after radical prostatectomy -- surgical removal of the prostate. They found that men who were given radiation therapy were about 60% less likely to die from prostate cancer than those who were not given radiation.

The greatest benefits of so-called salvage radiotherapy were observed in men with rapidly rising PSA levels, says researcher Bruce Trock, MD, associate professor of urology, epidemiology, oncology, and environmental health sciences at Johns Hopkins University.

On the flip side, there was no benefit to radiation if it was given more than two years after PSA started to increase, he tells WebMD. PSA (prostate-specific antigen) levels can be used to monitor prostate cancer patients.

No Standard of Care

There is no single standard treatment for men whose PSA levels shoot up after prostate-removal surgery, says Howard M. Sandler, MD, a radiation oncologist at the University of Michigan.

"About half the time, no treatment is given. This study shows that men who develop an elevated PSA after surgery should be referred promptly for radiation treatment because it will improve survival," he tells WebMD.

Sandler moderated a news briefing to discuss the findings, which are being presented later this week at the Genitourinary Cancers Symposium in San Francisco. He's an official with the symposium.

Trock says the findings have far-reaching implications. About 60,000 men underwent a radical prostatectomy in 2007, and up to 24,000 will suffer a recurrence within five years. About 6,000 of the men will eventually die of the cancer, he says.

Salvage Radiation Cuts Prostate Cancer Deaths

The study involved 635 men with rising PSA levels after radical prostatectomy: 160 received salvage radiotherapy alone, 78 received salvage radiotherapy plus hormonal therapy, and 397 received no treatment. Hormone therapy, which is also known as androgen-deprivation therapy, lowers the level of male hormones in the body, which can slow the growth of prostate tumors.

In the 10 years after their PSA started rising, 14% of the men who received salvage radiotherapy alone and 18% of the men who received salvage radiotherapy plus hormonal therapy died from prostate cancer.

In contrast, 38% of men who didn't receive salvage therapy died of the cancer.

Further analysis showed that the beneficial effect was limited to men whose PSA levels doubled in less than six months, indicating the presence of more aggressive disease.

Trock hypothesizes that men who had less aggressive disease probably would have fared well even without radiation therapy.

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