Dear OncoLink "Ask The Experts,"
I had a prostatectomy in December 2005 for prostate cancer. In August 2007, my PSA rose to .051 ng/mL, following a continuing increase from .01 ng/mL following surgery. I am seeking radiation therapy at a local hospital, where they offer 3DCRT for post-prostatectomy patients. Is this therapy necessary?
Richard Whittington, MD, Associate Professor of Radiation Oncology at the University of Pennsylvania School of Medicine, responds:
A PSA of 0.05 ng/mL may occur after prostatectomy and not necessarily mean that there is disease recurrence. Our group looked at the University of Pennsylvania series of about 210 prostate cancer patients status post prostatectomy. We found that 10% of the patients who had PSA levels of 0.20 ng/mL had spontaneous resolution of the PSA without any therapy. One patient hit 0.30 ng/mL and had resolution after passing a kidney stone. Our threshold is generally 0.40 ng/mL, which still appears to be a “safe” level to wait until, based on data from Dr. Erick Kline at the Cleveland Clinic. His work has demonstrated that the results with post-operative radiation that is initiated when the PSA level is <1.5 ng/mL appear to be just as favorable and successful as when it is started at a PSA level of <0.5 ng/mL.