1.Prostate Cancer Radiation after Surgery Robert Miller MD www.aboutcancer.com

2. Is there ever a need for radiation after a man has already had his prostate removed PostOp Radiation (Adjuvant Therapy) if the pathology report from the surgery raises the concern: was the cancer completely removed?Salvage Radiation 3. PostOp Radiation (Adjuvant Therapy): if the pathology report from the surgery raises the concern: was the cancer completely removed? How likely is it that the cancer will recur? How effective is radiation in preventing this? 4. NCCN.org 5. NCCN Advice on PostOp RadiationRP (radical prostatectomy) PLND (pelvic lymph node dissection) RT (radiation therapy) ADT (androgen deprivation therapy e.g. Lupron) 6. NCCN Advice on PostOp RadiationRP (radical prostatectomy) RT (radiation therapy) ADT (androgen deprivation therapy e.g. Lupron) 7. Adverse Features 1.Positive Surgical Margins 2.Invasion into the Seminal Vesicles 3.Extracapsular Extension 4.Detectable PSA (after surgery the PSA should fall to undetectable by a few weeks) 8. Prostate-specific antigen as a serum marker for adenocarcinoma of the prostate. Stamey TAAfter radical prostatectomy for cancer, PSA routinely fell to undetectable levels, with a half-life of 2.2 days. N Engl J Med. 1987 Oct 8;317(15):909-16. Prostate specific antigen in the preoperative and postoperative evaluation of localized prostatic cancer treated with radical prostatectomy. Oesterling JEthe half-life of prostate specific antigen was calculated to be 3.15 days. J Urol. 1988 Apr;139(4):766-72 9. PSA Half Life of 3 days Surgery612Percentage3 days 6 days 9 days 12 days 15 days 18 days 21 days 24 days 27 days 30 days 33 days3 1.5 .75 .375 .1875 .0937 .0468 .0234 .0117 .0059 (