20 doctors weighed in:

I am about to have a radical prostatectomy. What is the criteria for follow-up radiation therapy?

20 doctors weighed in
Dr. Gene Wong
Radiation Oncology
13 doctors agree

In brief: Latest update

There are two very recent clinical studies which showed high risk patients, that is patients with positive margins, seminal vesicles involvement and cancer spreading beyond the capsule, will get benefits from early adjuvant radiation after surgery rather than waiting until psa goes up.
They have a better chance of controlling and surviving the prostate cancer if they receive early radiation.

In brief: Latest update

There are two very recent clinical studies which showed high risk patients, that is patients with positive margins, seminal vesicles involvement and cancer spreading beyond the capsule, will get benefits from early adjuvant radiation after surgery rather than waiting until psa goes up.
They have a better chance of controlling and surviving the prostate cancer if they receive early radiation.
Dr. Gene Wong
Dr. Gene Wong
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Dr. Bahman Daneshfar
Radiation Oncology
3 doctors agree

In brief: Pathology/PSA result

It will depend on what the pathology results show.
For example if all the cancer is contained in the gland and margins are negative. Over time the psa needs to be checked and needs to be very low or zero. If it begins to climb upward, depending on the level or how quickly it goes up then radiation may be necessary. Luckily most that have surgery don't need radiation.

In brief: Pathology/PSA result

It will depend on what the pathology results show.
For example if all the cancer is contained in the gland and margins are negative. Over time the psa needs to be checked and needs to be very low or zero. If it begins to climb upward, depending on the level or how quickly it goes up then radiation may be necessary. Luckily most that have surgery don't need radiation.
Dr. Bahman Daneshfar
Dr. Bahman Daneshfar
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1 comment
Dr. Reza Shirazi
As Doctor Daneshfar wrote, the odds of you needing radiation after surgery is low, specially since MRI did not show disease extending outside of prostate
Dr. Andrew Turrisi
Radiation Oncology
2 doctors agree

In brief: Positive margin, psa

You did not say how old you are, what your gleason score or psa is now, but regardless, you should ask to see a radiotherapy doctor before you undergo surgery.
There are many options and many myths. Your best option is to get them ironed out and clarified before doing something you cannot undo.

In brief: Positive margin, psa

You did not say how old you are, what your gleason score or psa is now, but regardless, you should ask to see a radiotherapy doctor before you undergo surgery.
There are many options and many myths. Your best option is to get them ironed out and clarified before doing something you cannot undo.
Dr. Andrew Turrisi
Dr. Andrew Turrisi
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Dr. R. Scott Anderson
Radiation Oncology
1 doctor agrees

In brief: Adjuvant XRT

It depends some on the pathology at the time of the surgery.
Were the surgeons able to get out all of the tumor? Did it involve the lymph nodes? Did it involve the seminal vesicles? Most frequently, how does the psa respond to the surgery? Clear margins and an undetectable psa post-opeeratively are usually enough and no further treatment is needed.

In brief: Adjuvant XRT

It depends some on the pathology at the time of the surgery.
Were the surgeons able to get out all of the tumor? Did it involve the lymph nodes? Did it involve the seminal vesicles? Most frequently, how does the psa respond to the surgery? Clear margins and an undetectable psa post-opeeratively are usually enough and no further treatment is needed.
Dr. R. Scott Anderson
Dr. R. Scott Anderson
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Dr. Shalin Shah
Radiation Oncology
1 doctor agrees

In brief: Criteria:

Soon after surgery, the pathology that may make a radiation oncologist decide to offer radiation include: 1) positive surgical margin 2) extracapsular extension 3) perineural invasion 4) seminal vesicle involvement 4) positive nodes 5)few others your radonc will look at the pathology from surgery as well as your overall condition, etc to make a decision.

In brief: Criteria:

Soon after surgery, the pathology that may make a radiation oncologist decide to offer radiation include: 1) positive surgical margin 2) extracapsular extension 3) perineural invasion 4) seminal vesicle involvement 4) positive nodes 5)few others your radonc will look at the pathology from surgery as well as your overall condition, etc to make a decision.
Dr. Shalin Shah
Dr. Shalin Shah
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Dr. Carl Van Wey
Radiation Oncology

In brief: Radiation after surg

There is evidence that it is helpful if the tumor has spread to the seminal vesicles, has positive margins, or if the psa does not go to zero and stay at zero post-op.

In brief: Radiation after surg

There is evidence that it is helpful if the tumor has spread to the seminal vesicles, has positive margins, or if the psa does not go to zero and stay at zero post-op.
Dr. Carl Van Wey
Dr. Carl Van Wey
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Dr. Carl Van Wey
Radiation Oncology

In brief: Follow-up radiation

Radical prostatectomy and radiation therapy are equally effective.
If you have decided on surgery, about 10% of the patients need radiation post-op. There are 2 types: adjuvant radiation and salvage radiation. Adjuvant radiation is often recommended if there are positive margins or spread to the seminal vesicles, even if the psa goes to zero. Salvage radiation is indicated if psa is detectable.

In brief: Follow-up radiation

Radical prostatectomy and radiation therapy are equally effective.
If you have decided on surgery, about 10% of the patients need radiation post-op. There are 2 types: adjuvant radiation and salvage radiation. Adjuvant radiation is often recommended if there are positive margins or spread to the seminal vesicles, even if the psa goes to zero. Salvage radiation is indicated if psa is detectable.
Dr. Carl Van Wey
Dr. Carl Van Wey
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Dr. Alfred Tinger
Radiation Oncology

In brief: Depends on Pathology

Radiation should be considered after prostatectomy if the cancer has grown through the capsule out of the prostate or into the seminal vesicles or is seen at the edge of the specimen.
Other criteria can be close margins, involved lymph nodes, or a persistently elevated psa after surgery. It is always a great idea to meet with a radiation oncologist to review the pathology report after surgery.

In brief: Depends on Pathology

Radiation should be considered after prostatectomy if the cancer has grown through the capsule out of the prostate or into the seminal vesicles or is seen at the edge of the specimen.
Other criteria can be close margins, involved lymph nodes, or a persistently elevated psa after surgery. It is always a great idea to meet with a radiation oncologist to review the pathology report after surgery.
Dr. Alfred Tinger
Dr. Alfred Tinger
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