Last Fall, a study was presented in Atlanta GA, I believe, about a new approach (earlier treatment) to treatment with rising PSA following prostatectomy by Alan Pollack, MD, PhD, Chair of Radiation Oncology at the University of Miami and Deputy Director of the Sylvester Comprehensive Cancer Center.
The study has not yet been published yet but produced the following:
At 5 years following treatment, Freedom From Progression rates in the interim analysis group were
• 71.1% for PBRT alone (Prostate Bed Radiation Therapy)
• 82.7% for PBRT+ADT (Androgen Deprivation Therapy - hormone treatment)
• 89.1% for PLNRT+PBRT+ADT. (Pelvic Lymph Node Radiation Therapy)
At 8 years, distant metastasis found in:
• PBRT only - 45 patients
• PBRT+ADT - 38 patients
PLNRT+PBRT+ADT - 25 patients
It sounds like this will become the new treatment protocol for this scenario. It is the path I am now starting myself following my prostatectomy in November 2018.
Hopefully this will be helpful to someone.
It's not about earlier treatment. It's about using salvage radiation _ short-term ADT on the pelvic lymph nodes when there is biochemical recurrence after prostatectomy. In fact, those treated while their PSA was still very low did not benefit from whole pelvic radiation
I thought I had read that past practices were to wait until later stages but this indicated an earlier treatment. What is considered "very low" PSA that would not benefit? I looked for that when first reading the article but nothing was defined.
No, that was not the purpose of this study, and it is not standard of care to wait for later stages. They haven't yet published what they considered "very low." The minimum allowed PSA was 0.1; the maximum was 1.0.
Have you seen any further stratification of the data set somewhere, beyond what is here?: astro.org/ASTRO/media/ASTRO...
For example it does not even list the number of participants with each Gleason grade. It seems to me the results could be very skewed if there were a lot of G6's in the population.
It was just an early presentation at a conference. Results weren't expected for another 2 years. Read the first sentence:
Also, pay attention to the caveats at the end.
Tall Allen I am on similar path
Prostatectomy 8/18 ...........PSA 4 straight rises to. .12
RO. wants to start ADT for 6 months
Lupron and Casodex for1 month prior to radiation Prostate Bed Pelvic Lymph Node.
MO consult was not that helpful just agreeing with RO
I see conflicting data on this
Thank You for your time
I agree that it is not a good idea to see an MO when one is pursuing curative therapy.
What is the conflicting data you are seeing?
Hi Tall Allen. Thanks for your time conflicting treatment advice RO wants ADT
Astro Study. Says not helpful maybe even harmful. What’s your take ?
(knowing you are not giving medical advice )
All I know is in the links I provided above.
ok Appreciate your time. Just spoke to RO He said he understood That I wanted to "hold off" on Hormone Therapy. He said he just treated a Dr who requested the same so I think I am going with Radiation of Prostate Bed with Pelvic Lymph nodes
He also Agreed Based on all my data I should not have recurred but this will hopefully "cure" if there is such a thing thanks