Sometimes, it is unsafe to wait for a biochemical recurrence; sometimes, it is safe to put it off.
Exceptions to "early salvage" radiati... - Prostate Cancer N...
Prostate Cancer Network
Case made for Adjuvent RT - ART (within 6 mos of RP).By the numbers anyway (with Metastisis).
TA, I guess I must be reading this wrong? 10 yr all cause mortality incl positive lymph nodes is 14% vs 27%/28%. Do I hv this reversed? Isn’t ART Better?thanks for your patience,Mike
“Patients were treated with adjuvant (within 6 months of prostatectomy) radiation therapy (ART), salvage radiation therapy (SRT) after PSA rose above 0.2 ng/ml (biochemically recurrent - BCR), or no radiation therapy. They matched patients on age, initial PSA, and positive/negative margin status. 10-year all-cause mortality was:
for men with adverse pathology including positive lymph nodes:
14% for ART
27% for no RT
28% for SRT
for men without positive lymph nodes:
5% for ART
25% for no RT
22% for SRT
for men with no adverse pathology:
8% for ART
9% for no RT
8% for SRT
This suggests that for men with adverse pathology, ART improves outcomes over early SRT.”
What about that last line do you find confusing?
Nothing TA, it is what I originally said above yes? Or do I have it reversed? Dyslexia is my middle name. Mike
You commented that it applies to men with metastases, which I understood to mean stage M1. I replied that it applies to men without metastases. (it does apply to men with lymph node-only metastases (N1), but that is not a requirement.) Men with metastases (M1) are not candidates for salvage radiation - they are treated with salvage hormone therapy.
Leaning or relying on science, commonsense, luck, grace, and intuition. I am happy to report I am cancer free after 3 years.
I read, researched, meditated, prayed, and sought the best opinions I could find before I decided to go for SRT in February 2021 after my RP in March 2019. Though my PSA only rose to 0.05 after 20 months post RP, my team of urologists and oncologists let me make my own decision to go for SRT since I had a positive margin. I took a chance and here I am happy, healthy, and fit at 63 years old.
Today, My PSA came in at 0.003, three years after my initial PCa diagnosis in October 2018. Recurrence highly unlikely. I went for SRT early and it was the right decision.
Rock and Roll
Am I interpreting this correctly in concluding that someone could wait until the psa reaches >than .05? before treatment or are all 4 criteria required?
Zaorsky et al. point out some additional characteristics of recurrent patients who may be safely watched:
PSA < 0.5 ng/ml at time of recurrence
Age > 80 years of age
No distant metastases detected with PET/CT imaging (Ferdinandus et al)
"only 30% of BCR patients develop a clinically relevant recurrence" ...any idea what they mean by clinically relevant?
The study also lists characteristics that defined a "low risk" BCR prostate cancer that could be safely watched:
PSA doubling time > 1 year
Gleason score < 8
Interval to biochemical failure > 18 months
.... But how long could you watch for? A 0.05 PSA could be 1.6 in 5 years of watching if doubling time is 12 months ... Surely would need to undergo SRT before then?
Clinically relevant means not just a PSA recurrence, but some detected prostate cancer or symptoms.
PSADT begins at 0.1. They are saying that if it went to undetectable, slow growing, and GS<8, it can be safely watched. An annual PSA is a good idea.
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