Should i have radiation after prostatectomy

I was unable to move. I wonder, having read this article, whether waiting for a longer period, like six months before having radiation treatment, would have produced a different outcome. Thank you for the information, I hope perhaps somebody else reading your article might be spared the agony I went through. Thanks so much for writing The story you relate is unfortunately not that uncommon.

There is always an issue of assessing the effectiveness of adding radiation therapy to a patient who has had prior surgery; unfortunately, a small proportion of men develop the type of urinary complication that you had.

In the Annual report, we discuss a similar situation of a patient who developed a stricture years following removal of a portion of the prostate gland for benign enlargement, and this patient never had post operative radiation. We wish you the best in dealing with this and I am pleased that some normalcy has bee restored with the insertion of the Supra public catheter.

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Menopause and memory: Know the facts. How to get your child to put away toys. Is a common pain reliever safe during pregnancy? Briganti et al. By incorporating genomic tests into nomogram models, Den et al. Novel gene signatures describing the biology of prostate cancer progression have recently being summarized in a comprehensive review Certainly, when analyzing this data, one must consider that not all the patients treated with a PSA under 0.

Patients at risk of prostate cancer death had shorter time to relapse, shorter PSA doubling times, and higher Gleason scores 7. So far, only a few retrospective analyses have data on clinical significant endpoints. In the analysis by Boorjian et al. In addition, SRT decreased the rate of systemic failures Jereczek-Fossa et al.

The median time from surgery to radiation was 2. After a median follow-up time of The median biochemical-free survival after SRT was 2. The benefits of SRT should always be balanced against the morbidity of the therapy.

Many large retrospective series assessing oncological outcomes after SRT did not include long-term toxicity data. No differences in grade 2 or more late toxicity were observed. However, there were slightly more grade 3 late toxicity events in the ART group The 5-year PFS was The 5-year OS was Cause of death was progressive disease in 2.

This trial will require longer follow-up to see if the benefits observed in progression-free survival translate into the same OS benefit The study used a PSA rise above 0.

With the median follow-up of 6. Tiguert et al. Taylor et al. On the other hand, Trock et al. The primary outcome was prostate cancer-specific survival defined from time to recurrence to death. SRT alone was associated with a significant threefold increase in prostate cancer-specific survival relative to those who received no further treatment HR 0.

In this study, the addition of ADT was not associated with any additional increase in prostate cancer-specific survival. Notably, patients in the no-SRT group had a much higher prevalence of positive pelvic lymph nodes at recurrence.

It should also be noted that patients undergoing SRT should be correctly staged. However, conventional imaging investigations such as bone scan and computed tomography of the chest, abdomen, and pelvis have been very insensitive for patients with biochemical-relapsed prostate cancer after RP. Nevertheless, we perform these tests in our routine clinical practice because the detection of any distant metastasis obviates the need for local salvage treatment.

Cher et al. However, the use of MRI has enabled clinicians to assess the prostate bed more accurately. Miralbell et al. The use of conventional positron emission tomography PET tracers such as 18 F-fluorodeoxyglucose FDG is of no help in prostate cancer due to a low glycolysis rate and the renal excretion of the isotope into the bladder, enabling any local uptake. Rinnab et al. In a recent clinical series reported by Alongi et al. Vees et al. The lateral fields extended from the anterior aspect of the pubic symphysis and split the rectum posteriorly 8.

Inferiorly, the vesicourethral anastomosis should be included. The anastomosis is the most frequent area of positive prostate biopsies 53 , By placing the inferior field edge at the top of the bulb of the penis and adding a margin for uncertainties, there should be adequate coverage.

Laterally, the field should extend to about the medial aspect of each obturator internus muscle. Although the rectum is a landmark posteriorly, and its movement has been a matter of possible target missing, for this reason, a generous margin posteriorly is recommended in international guidelines The superior margin is more subjective and should be guided by the extent of disease at the prostate base and whether the seminal vesicles are involved In accordance with the well-described dose-escalation trials for primary RT of localized prostate cancer, it has recently been proposed that dose intensification either for SRT or ART would be more effective in terms of cancer control In the absence of results from randomized trials, the potentially improved local tumor control by a higher RT dose should be carefully weighted up against possibly increased toxicity.

An increase in the RT dose will certainly increase grade 3 or more late toxicity. Although theoretical assumptions might claim a benefit in escalating the RT dose, a randomized trial is needed to definitely answer this question. Patients with evidence of macroscopic recurrence or metastatic disease were excluded.

The trial included quality of life analysis, quality assurance of RT, and a central pathology review. Three-dimensional conformal or IMRT were allowed per protocol. Three hundred and forty-four patients were randomized.

Considering that this is an early report on toxicity, long-term toxicity as well as efficacy analysis is still pending. The study group included patients with PSA levels from 0.

The study closed in after accruing a total of patients. Its final publication is pending at present. Data indicated that the addition of ADT decreased the rate of death by prostate cancer and decreased the risk of the cancer metastasizing.

The year incidence of prostate cancer centrally-reviewed deaths was 2. Radiotherapy represents a curative approach to treat prostate cancer in patients with postoperative detectable PSA. The challenge of managing these patients in current clinical practice will be solved in the near future when the results of different on-going randomized trials become available. FH and DB both collected the data and drafted the manuscript. DB approved the submitted version of the manuscript. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

We are grateful to Julia Styles and Laurence Benoit for their help in manuscript preparation. National Center for Biotechnology Information , U.

Journal List Front Oncol v. Front Oncol. Published online May 9. Fernanda G. Herrera 1 and Dominik R. Dominik R. Author information Article notes Copyright and License information Disclaimer. Berthold, hc. Specialty section: This article was submitted to Genitourinary Oncology, a section of the journal Frontiers in Oncology. Received Feb 10; Accepted Apr The use, distribution or reproduction in other forums is permitted, provided the original author s or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice.

No use, distribution or reproduction is permitted which does not comply with these terms. This article has been cited by other articles in PMC. Keywords: adjuvant radiotherapy, prostate cancer, androgen deprivation. Introduction Prostate cancer is the most frequently diagnosed non-skin cancer in the western of world 1.

Table 1 Randomized controlled trials comparing adjuvant postoperative radiotherapy vs. NFT Thompson et al. Open in a separate window. Salvage Radiation Therapy Salvage radiation therapy is supported by some clinicians based on the rationale that an elevated PSA in the postoperative setting or a delayed PSA rise is caused, at least in some patients, by the persistence of local disease.

Table 2 Selected series of salvage radiotherapy for PSA relapse after radical prostatectomy. Table 3 Selected biomarkers tested in the postoperative setting. Radiological Assessment It should also be noted that patients undergoing SRT should be correctly staged. Conclusion Radiotherapy represents a curative approach to treat prostate cancer in patients with postoperative detectable PSA. Conflict of Interest Statement The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

References 1. The month of November takes on special significance for Mayo Clinic Urology, which joins the global Movember initiative to raise awareness of some of the most significant threats to men's health, including prostate and testicular cancers.

Prostate cancer is the most common cancer among men. Radical prostatectomy is a common and effective treatment for many men affected by the disease. At the time of prostatectomy, however, certain features are considered adverse due to increased associated risks of subsequent recurrence and progression, including seminal vesicle invasion, positive surgical margins and extraprostatic extension.

According to American Urological Association guidelines published in the Journal of Urology in , men with these adverse features should be counseled about the potential advantages of adjuvant radiation therapy ART. Level I evidence reported in the Korean Journal of Urology in demonstrated improvements in biochemical and local recurrence with ART.

However, significant debate persists about the relative risks and benefits of ART before evidence of cancer recurrence versus early salvage radiotherapy after recurrence, such as an increase in prostate-specific antigen PSA. Radiation therapy, like all forms of treatment, may be associated with an increased risk of complications, including incontinence, bladder neck contracture, bladder and bowel symptoms, secondary procedures, and secondary malignancies.

Therefore, reserving radiotherapy for those who will most benefit is of great concern. In an effort to learn more about this issue, urologist R. Jeffrey Karnes, M. As detailed in an article published in Urology in , the research team created a matched cohort to compare oncologic outcomes in patients who received ART with those who underwent a wait-and-see approach.