salvage radiation

[Guest guest]

I copied the following as an example of what one can find while looking for

success rates of salvage radiation. Let me state first, that I am biased against

prostactectomy. My husband underwent proton therapy a little over three years

ago at the age of 58. He has no continence issues, nor potency issues. His

current PSA test was .57 down from a pre-treatment level of 4.9. Gregg's HMO

urologist, who had nothing to lose or gain from Gregg's decision told us that

all of the current treatment methods have virtually the same success rate.

I should think that a valid question for a man in the treatment decision making

process, who is hanging his hat on being able to receive salvage radiation

should surgery fail, would be how successful is it.

The following suggests to me that it is not all that successful. One of the

problems is that there is no way to determine if the recurrence is local or

distant.

Something to think about, and I wonder how many men ask the question, " How

successful is salvage radition? "

Laurel

Over a 20 year period, 3478 patients underwent RP for clinically localized

prostate cancer by Dr. Catalona. Of these, 631 (18%) had evidence of cancer

progression after surgery. Of these, 307 patients received local radiation

therapy (median dose 63Gy) to the prostatic fossa. Of these, 223 patients had

sufficient follow-up data available for analysis. The authors then examined

clinical and pathological factors that predicted response to radiation therapy.

The median time from time from RP to PSA recurrence was 23 months (range 1-129).

There were 162 (73%) responders to radiation therapy defined as PSA < 0.3 ng/ml

after therapy. There was no difference noted with regards to clinical or

pathological stage, age at surgery, margin status, or interval between RRP and

radiation therapy between responders and non-responders. Gleason 8-10 was more

common in non-responders (28% vs. 13%) and the median PSA at start of radiation

was higher in non-responders (1.2 ng/ml vs. 0.7 ng/ml, p<0.01). There was a

trend towards a shorter PSA doubling time (PSADT) in non-responders which was

not significant (59% had PSADT < 10 months, vs. 39% with PSADT <10 months in

responders, p=0.06). Non-responders were more likely to have a preoperative PSA

> 20 ng/ml (67% vs. 47% in responders). The presence of seminal vesicle invasion

or lymph node involvement significantly correlated with a worsened outcome

following radiation (p=0.002).

The 5 and 10 year progression free survival for the entire cohort was 40% and

25%, respectively. The 5 and 10 year progression free survival for the patients

who responded to radiation therapy was 55% and 35%, respectively. Men with a PSA

< 1.3 ng/ml at the start of radiation therapy had a significantly better outcome

(p=0.027). In multivariate analysis, only the presence of seminal vesicle

invasion was associated with progression free survival after radiation therapy

for PSA recurrence (p=0.003).

This study demonstrates that while initial response to radiation therapy to the

prostatic fossa with PSA recurrence after RRP is good (73%), a durable response

out to 10 years from salvage radiation is only maintained in 25%. Patients who

do have an initial response to radiation therapy have the best outcome, with 35%

progression free at 10 years. Further maturation of this data will determine the

affect of salvage radiation therapy on patient cancer specific survival.

By Christoper G. Wood, MD

[Guest guest]

The problem with this is - what is PSA recurrence? The Phoenix definitions seem to be flawed. In that recent brachytherapy follow-up study 44% of men thought to have experienced bichemical failure were experiencing PSA bounce. My own experience, a GS 9, PSA 63 diagnosis reducing to PSA 0.3 nadir after radiotherapy and ADT but bouncing around thereafter and currently 0.7 for six months, two and and a half years after diagnosis tends to support doubts about the "recurrence" criteria. If PCa comes back to me, I'm not going to believe it until/if PSA hits 4 or so and then not until at least three years after completion of EBRT. I want to be sure that PCa cells are not still in their death throes and distorting the numbers.

All I've learned over the period since diagnosis suggests that over-treatment is a real danger. Treatment itself is a nasty enough experience without going through unnecessary troubles.

No expert views here - just my five penn'orth (or should that be dimesworth, if you colonial cousins prefer).

To: ProstateCancerSupport Sent: Wednesday, 5 May, 2010 20:54:50Subject: salvage radiation

I copied the following as an example of what one can find while looking for success rates of salvage radiation. Let me state first, that I am biased against prostactectomy. My husband underwent proton therapy a little over three years ago at the age of 58. He has no continence issues, nor potency issues. His current PSA test was .57 down from a pre-treatment level of 4.9. Gregg's HMO urologist, who had nothing to lose or gain from Gregg's decision told us that all of the current treatment methods have virtually the same success rate.I should think that a valid question for a man in the treatment decision making process, who is hanging his hat on being able to receive salvage radiation should surgery fail, would be how successful is it.The following suggests to me that it is not all that successful. One of the problems is that there is no way to determine if the recurrence is local or distant. Something to think about, and I

wonder how many men ask the question, "How successful is salvage radition?"LaurelOver a 20 year period, 3478 patients underwent RP for clinically localized prostate cancer by Dr. Catalona. Of these, 631 (18%) had evidence of cancer progression after surgery. Of these, 307 patients received local radiation therapy (median dose 63Gy) to the prostatic fossa. Of these, 223 patients had sufficient follow-up data available for analysis. The authors then examined clinical and pathological factors that predicted response to radiation therapy. The median time from time from RP to PSA recurrence was 23 months (range 1-129). There were 162 (73%) responders to radiation therapy defined as PSA < 0.3 ng/ml after therapy. There was no difference noted with regards to clinical or pathological stage, age at surgery, margin status, or interval between RRP and radiation therapy between responders and non-responders. Gleason 8-10 was more common

in non-responders (28% vs. 13%) and the median PSA at start of radiation was higher in non-responders (1.2 ng/ml vs. 0.7 ng/ml, p<0.01). There was a trend towards a shorter PSA doubling time (PSADT) in non-responders which was not significant (59% had PSADT < 10 months, vs. 39% with PSADT <10 months in responders, p=0.06). Non-responders were more likely to have a preoperative PSA > 20 ng/ml (67% vs. 47% in responders). The presence of seminal vesicle invasion or lymph node involvement significantly correlated with a worsened outcome following radiation (p=0.002). The 5 and 10 year progression free survival for the entire cohort was 40% and 25%, respectively. The 5 and 10 year progression free survival for the patients who responded to radiation therapy was 55% and 35%, respectively. Men with a PSA < 1.3 ng/ml at the start of radiation therapy had a significantly better outcome (p=0.027). In multivariate analysis, only the

presence of seminal vesicle invasion was associated with progression free survival after radiation therapy for PSA recurrence (p=0.003). This study demonstrates that while initial response to radiation therapy to the prostatic fossa with PSA recurrence after RRP is good (73%), a durable response out to 10 years from salvage radiation is only maintained in 25%. Patients who do have an initial response to radiation therapy have the best outcome, with 35% progression free at 10 years. Further maturation of this data will determine the affect of salvage radiation therapy on patient cancer specific survival. By Christoper G. Wood, MDThe problem with this is - what is PSA recurrence

[Guest guest]

Alan Meyer wrote:

> There is a wonderfully useful discussion of salvage radiation

> in the following article:

>

> http://www.prostate-cancer.org/pcricms/node/59

Oops. Sorry, that was a higher level link than I should have posted.

The specific link is:

http://www.prostate-cancer.org/pcricms/sites/default/files/PDFs/Is13-2_p8-17.pdf

The link I posted is to a lot of publications on the same site. The

specific one is in the May, 2010 issue. The link above gets you

right to it.

Alan

[Guest guest]

Thank you Alan;That info was just what I was looking for. It sure answers a lot of questions for me. Just had RP don the 7th of June. Your post couldn't be more timely for me.Thank you again,Dan Harriman just starting down this new journey.Tyler TexasIf at first you don't succeed, maybe you shouldn't try sky diving!> There is a wonderfully useful discussion of salvage radiation> in the following article:> > http://www.prostate-cancer.org/pcricms/node/59Oops. Sorry, that was a higher level link than I should have posted.The specific link is: http://www.prostate-cancer.org/pcricms/sites/default/files/PDFs/Is13-2_p8-17.pdfThe link I posted is to a lot of publications on the same site. Thespecific one is in the May, 2010 issue. The link above gets youright to it. Alan ------------------------------------There are just

two rules for this group 1 No Spam 2 Be kind to othersPlease recognise that Prostate Cancerhas different guises and needs different levels of treatment and in some cases no treatment at all. Some men even with all options offered chose radical options that you would not choose. We only ask that people be informed before choice is made, we cannot and should not tell other members what to do, other than look at other options. Try to delete old material that is no longer applying when clicking replyTry to change the title if the content requires it