As a general rule, men with organ-confined cancer or men with cancer that has penetrated the prostate but still was removed in its entirety (men who had “negative surgical margins”) and Gleason scores of 6 or less should not receive radiation therapy after radical prostatectomy.
The best candidates for radiation after radical prostatectomy are men who have positive surgical margins—but cancer that has not yet reached the pelvic lymph nodes and seminal vesicles. However, even this is not a crystal-clear decision; not all of these men are going to need radiation. For many of these men, the radical prostatectomy will be enough to control the cancer. One option is for men to have regular PSA tests and begin radiation treatment only if the PSA starts going up.
And there’s yet another consideration: Not all of these men with rising PSAs are going to be helped by the radiation, because of the problem with distant metastases we mentioned above. So what you and your doctor need to determine is, why is the PSA going up? Is it local recurrence of cancer, or the presentation of distant metastases?
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