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Prostate Cancer

At What PSA Level Is Radiation Not Effective

04/07/2009

Question:

Cancerous prostate was removed 10 years ago. Current age -75 In Sept. 2008 when PSA level reached 0.54 my urologist recommanded radiation treatment. In Dec. 2008 PSA level went down to 0.48 - my urologist recommanded to pospond the radiation till March 09. On March 2009. PSA level is 0.5 The urologist recommand to wait with the radiation and to continue with PSA checking. 1) Is there a PSA level that by reaching it the radiation treatment will be useless? 2) Might hormonal treatment be as effective as radiation in my case? Have no health problem, take no drugs, continue with normal working procedure.

Many thanks for your reply.

Answer:

Experts vary in the exact psa level after which radiation will not cure psa rises after surgery for prostate cancer. However, after saying that, the decision to recommend radiation for a 75 year old asymptomatic man, 10 years after radical prostatectomy, is complex. The variables include in no particular order of importance: your estimated life expectancy, your urinary continence, your potency, your bowel function and your overall health.

Prognosis regarding your prostate cancer depends when after your prostatectomy the PSA started to rise, PSa doubling time, the grade of the original tumor, whether or not the doctor can feel on digital rectal examination the tumor, and factors that we may not completelly understand. As tge PSA is only about 0.5 now this is a very good progostic fact in your case.

In general, CT, MRI, and or bone scan do not show the presence or absenc of prostate cancer if it is present when the PSA is this low. A test called Prostasint and in some hands PET scaning are used to try to see where the cancer is because if the cancer is not in the area where your prostate used to be, radiation aimed to the pelvis will not be able to cure it.

Your treatment choices that your urologist has are watching you with PSA and physical examination every 4-6 months, radiation to where the prostate used to be, and hormone deprivation therapy--and choosing the one best for you depends on the estimation of the risk to your life and well being from the tumor and or from the treatment because the treatments all have significlant side effects. For these reasons a decision regarding this PSA and the possibility that your cancer is back is not simple and I recommend that you take it seriously as you did your initial daignosis of prostate cancer.

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Response by:

R Bruce  Bracken, MD R Bruce Bracken, MD
Professor of Surgery
College of Medicine
University of Cincinnati