To minimize risk of metastases, treat with salvage radiation while PSA is below 0.5. If PSA becomes detectable and starts to rise after prostatectomy, salvage radiation can still cure the cancer. But exactly when should a man get it? This has been the subject of debate, says radiation oncologist Daniel Song, M.D., Co-Director of the Brady’s Prostate Cancer Multidisciplinary Clinic. “Should patients receive radiation while their PSA is very low but detectable, or is a wait-and-see approach better?”

In a recent study, Song and colleagues answered this question – and their findings, published in Prostate, could be practice-changing.  “We analyzed the data on nearly 400 patients who were treated with salvage radiation at Johns Hopkins,” Song says. “Not unexpectedly, patients who had lower Gleason scores and absence of seminal vesicle invasion did better than those who did not.” However, they found the strongest predictor of whether a man’s PSA would keep going up after salvage radiation was his PSA level before radiation treatment.

“Men who received treatment before their PSA rose above 0.5 were 60 percent less likely to have long-term PSA failure.” And even better: “These men were also about 40 percent less likely to have cancer found in the bone or lymph nodes” (better metastasis-free survival).