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High PSA after prostatectomy. Get radiation therapy alone, or hormone therapy as well? Dosage?

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Practicing since : 2002
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My father has a high psa again (0.2) two years after laparoscopic prostatectomy for an aggressive prostate cancer (gleason grade 9). should he get just radiation therapy alone, or hormone therapy as well ? on the radiation therapy, should it cover the pelvic lymph nodes also or just the prostate bed? what total dosage would you recommend? on the hormones, how long should he take it for? is there any advantage in getting proton beam therapy for the prostate? his cancer is not metastatic as far as we know (bone scan and CT abd/pelvis negative) and there was no lymph node biopsy done initially as the XXXXXXX grade on the biopsy was low (3+3), but after surgery was upgraded to a 9 (4+5).
Posted Sun, 15 Apr 2012 in Cancer
Answered by Dr. Robert Galamaga 1 hour later
Hello and thanks for the query.

Usually with a PSA recurrence which is how we define this, hormonal therapy is certainly indicated. Radiation therapy can be used as well to help eradicate any minimal residual disease which may be remaining.

Radiation therapy must be carefully planned so as to spare negative side effects to the colon and surrounding tissues. Sometimes an endorectal coil MRI can be done to further analyze the soft tissue in the area to see if there are obvious growths or lymph node swellings.

Proton beam therapy is a very new therapy. You would need to have a careful discussion with the radiation oncologist and ask him for statistics on comparing intensity modulated radiotherapy which is contoured to the region which needs to be treated versus proton therapy. I would generally support radiation of both the prostate bed and regional lymph nodes as this is the most likely area where there are some cancer cells remaining. Unless the radiation oncologist argues otherwise I would support conventional radiotherapy using IMRT to those areas. I think an MRI may be helpful as well prior to any additional treatment.

After radiotherapy, serial PSA measurement can be done and if it remains undetectable you can observe for a period of time. If it begins to climb after - hormonal therapy can be initiated. There is somewhat of an art to this and each patient has to be individualized in a treatment sense.

I thank you again for the query and hope this response has served to be adequate and informative. Regarding the total radiation dose this really depends on his anatomy and how the computerized algorithm approaches the target area - so dosage will vary based on that. If you have any additional concerns I would be happy to address them.


Dr. Galamaga
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