If your PSA starts to rise after you’ve undergone Prostatectomy, “salvage” radiation therapy might be a good option to explore. With this approach, External Beam Radiation Therapy is delivered to the area immediately surrounding where the prostate used to be (called the prostate bed), in the hopes of eradicating any remaining prostate cells that have been left behind. Approximately 80% of men who have a rising PSA after surgery have disease in the prostate bed.

Brachytherapy is not an option because there is no prostate tissue in which to embed the radioactive seeds.

But the procedure is not for everyone. If there are obvious sites of disease outside of the pelvis, just as metastatic disease, salvage radiation therapy is likely not the best choice as it only will treat the prostate bed and potentially the nearby lymph nodes.

The best time to receive salvage radiation therapy is when your PSA first becomes detectable, ideally when it is ≤0.2 ng/mL.  Once the PSA is above 0.5 ng/mL cures rates with salvage radiotherapy by itself start to fall off fast.  For men with PSAs of >0.5 ng/mL usually hormone therapy is added to salvage radiation therapy to improve the cure rate, which has been shown to be effective in multiple trials.

Side effects from salvage radiation therapy are largely dependent on the amount of side effects you suffered from the surgery.  If you have excellent urinary function without incontinence and great erectile function, you are likely to have mild side effects after radiation therapy.  However, if you have some degree of urinary incontinence already or poor erectile function, salvage radiation therapy has the potential to worsen these to a more noticeable degree.  In general, salvage radiation therapy (like all salvage therapies) is more likely to cause more side effects than upfront radiation therapy.  The side effects are also additive to those previously received with surgery. These include rectal bleeding, Incontinence (urinary leakage), strictures and difficulty urinating, diarrhea, and fatigue. Be sure to discuss with your doctors what you can reasonably expect before deciding on a course of therapy. In some cases, Hormone therapy might be added for a short period before radiation to allow your urinary function to heal, or during the radiation treatment.

Learn More