Prostate cancer findings suggest radiation therapy should not be routinely given post-surgery

Radiation therapy targets malignant cells missed in surgery, or cancer that has spread, but comes with risk of urinary troubles

Studies suggest that delaying radiation treatment until PSA blood test levels signal a reoccurrence could save many men from overtreatment

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Routinely giving post-surgical radiation does not improve outcomes for prostate cancer patients after five years compared with giving radiation only if blood tests signal a cancer recurrence, new studies say. Photo: Shutterstock

Published: 9:15pm, 9 Oct 2020Updated: 9:15pm, 9 Oct 2020

One of the thorniest dilemmas posed by prostate cancer is whether, and when, to give radiation therapy – with its potential bad side effects – to men after surgery to remove the prostate gland.

Now, three new randomised clinical trials and a statistical “meta-analysis” of their results conclude that routinely giving post-surgical radiation does not improve outcomes after five years, compared with giving radiation only if the PSA (prostate specific antigen) blood test signals a cancer recurrence. The papers were published last month in The Lancet and The Lancet Oncology.

“All the surgeons have always struggled with this,” said Alexander Kutikov, a urological oncologist at the Fox Chase Cancer Centre in the US city of Philadelphia, in the state of Pennsylvania. “You don’t want to overtreat, but you don’t want to lose the window of opportunity. These trials really crystallise that you can hold off on radiation. It has changed my practice.”

That change has benefited not only Kutikov’s post-surgical patients, but also men like James Boughter, 56, a Philadelphia-based machinist who had surgery six years ago.

“We were keeping an eye on [the PSA] every six months,” said Boughter, whose PSA became detectable – barely – about a year ago, but has been stable at that low level. Based on the latest research, Kutikov assured Boughter that he could hold off on radiation, and hopefully forgo it altogether.