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

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.
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.
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.
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.
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.
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.
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.
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.

Related Questions

After radical prostatectomy followed by radiation therapy in 3 months. Can the cancer comes back?

Salvage Radiation. Yes, there is a small but definite risk of the cancer coming back after salavage radiation for prostatectomy. Periodic psa surveillance is indicated as adviced by your oncologist. If detected early you may have other treatment alternatives to consider. Read more...
It can. Risk of biological failure, when the psa blood test continues to increase or drops and then increases above what it originally was, is dependent on cells leaking outside of the prostate capsule. This risk is somewhat predictable based on original psa, t stage, and gleason score as well as how much tumor was in the prostate. Xrt after surgery tells me there was concern about leftover cells. Read more...

After radical prostatectomy followed by radiation therapy in 3 months. Can the cancer come back?

Yes. Unfortunately, there is always a chance the cancer come back despite undergoing surgery followed by radiation. Therefore, it is important you are under surveillance by your doctors. Read more...
Possibly. The risk of this depends mainly on the pathologic findings (ie, stage and gleason grade) at surgery as well as preoperative psa. There are "nomograms" or calculators of this risk available to estimate such risk. Nomograms.Mskcc.Org/prostate/salvageradiationtherapy.Aspx is one which you might find useful. Read more...

After surviving a radical prostatectomy followed by radiation therapy 6 yrs ago I have had an itchy left breast which has at times been weepy. Psa. 4?

Probably unrelated . Probably unrelated but there may be some gynecomastia and if so this might warrant treatment. Either medical or a short course of radiation should help. I would see a pcp and ask if you need a scan or biopsy to r/o gynecomastic mastitis. Read more...
The common cause. Of 'breast' enlargement, discharge would be hormone management: Bicalutamide is highest. You need an exam. The fact that you have a single > 0.1 psa worries me. Get another. The breast issue is unlikely to be cancer related; however you need an exam, and a diagnosis. Read more...

I am about to undergo radiation therapy after a prostatectomy. What side effects, if any, can I expect?

At consent for. Treatment, these should be listed and discussed. I wait until continece is achieved before starting, usually 3 mos post op (+ margin, capsule penetration). If psa is rising, caution about urinary continence, freq, urgency, nocturia, fatigue during xrt, bleeding from rectum is a late effect. Risks <5-10%. Dose & # of treatments, volume all issues. If nodes are treated, diarrhea is posible. No n&v. Read more...
Mild and transient. For the large majority of men, modern postoperative radiation for prostate cancer is well-tolerated. Men may experience irritative urinary symptoms (frequency, burning) and loose stools. Fatigue may be present particularly after the first few weeks. Many men experience few if any symptoms. In most patients, these symptoms resolve after cessation of therapy. Seek out a center with modern equipment. Read more...
Fatigue, LUTS, ED. While undergoing the radiation you will have some fatigue, maybe some urinating irritation and bother with erections. Most go away when treatment over. For more info @thepeedoc www.Peedoc. Read more...
Bladder and bowel . We use radiation therapy following prostatectomy for several reasons. But the side effects are the same. Irritation of the lower urinary tract with frequency and urgency are common as well as some potential discomfort with urination. Also there may be some change in bowel movements that can usually be controlled with diet. Fatigue is common but can be combatted with some regular exercise. Read more...

I had a radical prostatectomy in which one nerve was removed. I will have follow-up radiation. I am 57. What are my chances of regaining potency?

Prostate cancer pote. Your chances are not very good I am sorry to say after prostatectomy and radiation.Discuss your options with your urologist.Some times drugs like viagra (sildenafil) and Cialis may be some help. Read more...
Poor. Unfortunately, majority of men treated with both surgery and radiation have a poor chance to regain complete potency without use of ED therapy (medication, vacuum device, prosthesis). Fortunately, there are solutions available (as listed) so all hope is not lost. Your main priority right now is treating your cancer. Discuss this with your urologist. Read more...
Poor. Unfortunately, if your entire nerve was removed and you had good function before, most surgeons tell there patient that you have a 50% chance of regaining function. Once you have radiation, the odds will slip even more. Find a urologist who will be aggressive in helping with your sexual rehabilitation after surgery. Read more...
It depends. If you had good sexual function preoperatively and a well-spared neurovascular bundle on one side there is a reasonable chance that you can recover sexual function, as age and preoperative function are the strongest predictors of recovery. However, the radiation therapy may negatively impact sexual function, even in men who have not had surgery. Aggressive rehabilitation measures may help. Read more...