What is Salvage or Adjuvant Radiation?

Radiation after prostatectomy can be used in two settings:

  • Salvage Radiation: Given if PSA begins to rise (biochemical recurrence) after surgery, suggesting cancer cells remain.
  • Adjuvant Radiation: Offered soon after surgery if high-risk features are seen in the pathology report, such as positive margins, seminal vesicle invasion, or extracapsular extension.

Both approaches use targeted external beam radiation to the prostate bed, aiming to destroy microscopic cancer cells before they grow or spread.

Why Radiation May Be Recommended

  • To lower PSA and reduce risk of recurrence.
  • To delay or avoid systemic therapy like long-term hormone therapy.
  • To improve cure rates for men with high-risk features after surgery.
  • Studies show salvage radiation is most effective when started early (at very low PSA levels).
  • Adjuvant radiation reduces risk of recurrence in men with high-risk pathology.
  • Modern radiation is precise, sparing surrounding bladder and rectum.

What to Expect During Treatment

Radiation is delivered as daily outpatient treatments, typically Monday through Friday, for several weeks. Each session lasts only a few minutes, and the treatment itself is painless. You will lie on a treatment table while a machine delivers targeted beams to the prostate bed.

Side Effects and Recovery

  • Short-term: Fatigue, mild urinary urgency or frequency, loose stools or rectal irritation.
  • These effects are usually temporary and improve after treatment.
  • Long-term (less common): Ongoing urinary leakage, erectile dysfunction, or rectal bleeding.
  • Your care team will monitor closely and provide treatments to minimize these effects.

Monitoring and Follow-Up

  • Regular PSA blood tests to track response to treatment.
  • Follow-up visits with your urologist and radiation oncologist.
  • Additional imaging such as PSMA PET scans if recurrence is suspected.
  • Supportive care for urinary or bowel symptoms, if needed.