Recurrence patterns after RP, RT and sRT assessed by PSMA-PET/CT

[Justfor_]

Useful information before embarking into any blind treatment.

dRT = definitive RT

"Results:

787 patients were included in the analysis. Positive scan rates were 60%, 94% and 75% in RP, dRT and RP + SRT populations, respectively. Median pre-scan PSA levels were 0.50 (0.02-72.5) ng/ml, 4.4 (0.1-202) ng/ml, and 1.07 (0.04-33) ng/ml for patients who underwent RP (n = 464), dRT (n = 109) and post-RP SRT (n = 214). Median time to first recurrence was 27.7 after RP and 54.6 months after dRT (p = < 0.0001). Patients who underwent RP had lower local recurrence (LR) pattern (T+) rates by PSMA PET than those with dRT (99/464; 21% vs 69/109; 63%; p = < 0.0001). Nodal metastasis (N1) positivity rate was similar between RP and dRT (179/464; 39% vs 43/109; 39%; p = 0.87). Extrapelvic metastasis (M1) positivity rate was lower for RP than dRT (93/464; 20% vs 51/109; 47%; p = < 0.0001). Median time from post-RP SRT to second recurrence was 22.3 months. In patients who had a second recurrence after RP and SRT the positivity rate of LR (T+), N1 disease and M1 disease by PSMA PET/CT was 12% (24/214), 46% (99/214) and 44% (95/214). Conclusions: In this cohort of patients with nmCS PCa recurrent disease after primary definitive therapy, the patterns of failure differ based on prior local treatments."

ascopubs.org/doi/abs/10.120... (2020)

Note 1: Lousy arithmetic, as (24+99+95)/214=218/214=102%

Note 2: The published original includes some info pertaining to dRT + ADT - vs - dRT alone, that didn't make the text above.

researchgate.net/publicatio...

[maley2711]

do you view this as definitive that surgery outperforms radiation??

[Justfor_ in reply to maley2711]

No. My view is to try to find the nature of the cancer before deciding on either treatment. Regarding RP vs dRT, this is an apple to oranges comparison for the following reasons:

People undergoing dRT have a mean older age compared to those electing RP and due to this a more advanced disease plus comorbidities.

1) Comparing overall survival is not fair for the former as immortality does not exist.

2) Comparing cancer specific survival is not fair for the latter as the former will most likely die from something else.

3) Comparing recurrence is not meaningful as there are two different criteria for each case (>nadir +2 for the former vs >0.2 for the latter).

My personal view is that the combo RP + sRT buys more time compared to dRt + ADT.

[maley2711 in reply to Justfor_]

Thanks. prostatecancerfree.org (?) argues that time to recurrence is the most important......perhaps based on the view that recurrence means more nasty treatments.But, as you say, recurrence is measured differently for surgeryy and radiation....so not fair to surgery?

Have you seen studies re your last sentence? It's all bad...one thing we do know!

[Justfor_ in reply to maley2711]

Have not run across any, but I do not need them either. My common sense tells me that in any incurable case like this the best strategy is defence. The more defencive positions, the farther the final defeat.

[maley2711 in reply to Justfor_]

well, certainly, surgery +RT + ADT is more defense........ I'm just hoping RT at age 72 would be enuf??? Surgery spooks me more than RT.....maybe undeservedly?

[Justfor_ in reply to maley2711]

I very well know where you are standing at as I have been there. Two years ago, when diagnosed at the age of 69 my first thoughts were about primary RT. For four months I was balancing on a knife's edge. Finally, RP won on the gamble that it will give me 2-3 years before next treatment. Now, after a year and a half, it seems that the 2 years will probably materialize (one can never be too certain), while the 3 are most probably unattainable. I am happy that my risk-reward based decision proved realistic. To be truly open with you, I can't guarantee that I would had landed on the same decision if I were 72 then. My only regret is that I didn't take a PSMA PET/CT then, after listening to my urologist who dissuaded me. I intend to rectify this in the not too distant future. Good luck with your decision, whichever this may be.

[maley2711 in reply to Justfor_]

Thanks for your comments!!!!!