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Wednesday, May 22, 2013
Do I Need to Begin Radiation?
My PSA following RP surgery was .0. After 4 yrs it has been .2 for 12 months. My physician has done a bone scan, PET/CT, prostacint and biopsy and found nothing. I am being pushed to begin radiation. Am I in danger if I wait longer?
I think you can wait safley until the PSA reaches 1.0 to begin radiation therapy. This is the art of medicine, not the science. The data shows me that radiation reduces PSA to undetectable levels 5 years after it is administered as long as PSA is 1.0 or less when it is started. I know of no data that show results are better if radiation starts at say .2 than at higher levels that are less than 1.0.
Different authorities use different PSA levels to recommend radiation. For example Mayo Clinic recommends waiting until PSA exceeds 0.4 and I use this PSA number myself. You might not see your PSA rise much above where it is now and if it does not then you could avoid the radiation.
R Bruce Bracken, MD
Professor of Surgery
College of Medicine
University of Cincinnati