PROSTATE CANCER TREATMENT: RADIATION AFTER PROSTATECTOMY
PSA is a good litmus test for the success of prostate cancer treatment: Soon after radical prostatectomy, a man’s PSA level should plummet—ideally, into oblivion. If it doesn’t drop that far, or if it goes away and comes back, some patients move to Plan B—external-beam radiation treatment. (This is the opposite of the situation described above, and the long-term prognosis is often different for these men.)
Radiation after prostatectomy is also used in some men who have “positive surgical margins”—if the edges of the removed tissue show cancer cells. However, there are several considerations here: One is that just because the surgical margins are positive does not necessarily mean that cancer is left behind. How can this be? When cancer reaches beyond the prostate to invade nearby tissue, it produces a dense scar tissue that acts, as one surgeon describes it, “like Super Glue.” As a surgeon removes the prostate, this thick scar tissue sticks to the surrounding cancer cells—picking them up like a lint brush. So in some cases, although the pathologist may see cancer cells at the margin—and make a judgment of “positive surgical margins”—there are no cancer cells left inside the patient; the sticky scar tissue took them all away.
A study at Johns Hopkins involved such instances, when a surgeon removed the prostate, looked at it, suspected that some cancer cells were present, went back and cut out more of the surrounding tissue. Even when the pathologist believed there was a positive surgical margin at the edge of the prostate, in 40 percent of these patients there turned out to be no cancer left behind in that adjacent tissue.
Another factor to consider here is that in patients with cancer that has extended beyond the prostate to the point where it is not possible for surgeons to remove it all, it’s a pretty likely bet that there are other cancer cells floating around elsewhere—that cancer has already escaped from this tissue near the prostate, that it has already metastasized. And that any attempts at local treatment (such as radiation to this area) will not be able to reach all the cancer. Finally, radiation after radical prostatectomy can make a man more prone to problems with urinary control and sexual function; the radiation may damage tissue already made vulnerable by the surgery.
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Tags: Erectile Dysfunction, Men’s Health