We just received our appointment summary from the radiation oncologist and there is a comment in it that is confusing me. It’s not how I remember the conversation, so I am wondering if someone can clarify ( Tall_Allen ?).
”We can proceed with EBRT followed by LDR brachytherapy boost and minimum 6 months of ADT (as per Japanese randomized trial (IJRPBP 2023), where 6 months vs 24 months of hormones together with EBRT prostate brachytherapy boost in high risk patients yield completely the same results). PSA progression free survival as per Japanese trial as well as ASCENDE RT Canadian trial for this particular scenario is about 10-15% at 10 years.”
The progression free survival rate seems very low at 10 years. I thought it was much higher and that this was the reason for people recommending brachytherapy boost for high risk over surgery. Is this a typo or is this the case? I will probably reach out tomorrow to clarify with her office if I can, but curious if anyone knows the answer.
Thank you!
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EvFC
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Thank you. Those were her notes and she didn’t provide the details of the study. My recollection was that recurrence rate was around 15% so your stats make more sense to me. Appreciate your response.
What is your view on the efficacy of focal boost for appropriate patients? RO feels it could provide results approaching those with brachy boost, but better toxicity profile? Also, instead of fiducials, will use calcium deposits to help with daily alignments over 28 sessions. Apparently an option would have been traveling 700 miles to have brachy at Kaiser NoCal. Right now , 28 sessions of WPRT with focal boost to PIRADS 5 area transition zone. Younger RO MIT grad and Harvard -trained.....knows Kishan " smart guy". No luck selling him on E2 low dose patches tohelp with osteopenic situation.
Wrote: "progression free survival" where the Japanese trial's primary endpoint was "cumulative incidence of biochemical progression "
"Methods and materials: This study was conducted at 37 hospitals on men aged 40 to 79 years, with stage T2c-3a, prostate-specific antigen >20 ng/mL, or Gleason score >7, who received 6 months of ADT combined with iodine-125 brachytherapy followed by EBRT. After stratification, patients were randomly assigned to either no further treatment (short arm) or 24 months of adjuvant ADT (long arm). According to the Phoenix definition of failure, the primary endpoint was the cumulative incidence of biochemical progression. Secondary endpoints included clinical progression, metastasis, salvage treatment, disease-specific mortality, overall survival, and grade 3+ adverse events. An intention-to-treat analysis was conducted using survival estimates determined using competing risk analyses.
Results: Of 332 patients, 165 and 167 were randomly assigned to the short and long arms, respectively. The median follow-up period was 9.2 years. The cumulative incidence of biochemical progression at 7 years was 9.0% (95% CI, 5.5-14.5) and 8.0% (4.7-13.5) in the short and long arms, respectively (P = .65). The outcomes of secondary endpoints did not differ significantly between the arms. Incidence rates of endocrine- and radiation-related grade 3+ adverse events for the short versus long arms were 0.6 versus 1.8% (P = .62) and 1.2 versus 0.6% (P = .62), respectively."
Thank you. This is more in line with what I remember from our conversation with her. Thank you for providing the links to the study. I appreciate your response.
Here is a good website to compare odds of cure for the major treatment paths. You have to determine your stage, low risk, intermediate, or high risk (risk of recurrence). So if you are intermediate, pull up the intermediate chart and you can see the odds of 10-20 yr survival, etc. based on the treatment you pick.
It is best viewed on computer or just print it on paper. Not so viewable on phone.
To make the graphs easier to read, i drew a dot on the endpoints of the elipses, and then drew a line through the dots. This turns the elipses into lines.
Also be aware the the graphs don’t show any salvage radiation benefit. This would boost the surgery odds up a bit.
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