Exceptions to "early salvage" radiation treatment for recurrence after prostatectomy

[Tall_Allen]

Sometimes, it is unsafe to wait for a biochemical recurrence; sometimes, it is safe to put it off.

prostatecancer.news/2021/10...

[Spyder54]

Case made for Adjuvent RT - ART (within 6 mos of RP).By the numbers anyway (with Metastisis).

[Tall_Allen in reply to Spyder54]

Without metastases.

[Spyder54 in reply to Tall_Allen]

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.”

[Tall_Allen in reply to Spyder54]

What about that last line do you find confusing?

[Spyder54 in reply to Tall_Allen]

Nothing TA, it is what I originally said above yes? Or do I have it reversed? Dyslexia is my middle name. Mike

[Tall_Allen in reply to Spyder54]

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.

[Spyder54 in reply to Tall_Allen]

Got it. Thanks for your patience.

[Steve507 in reply to Spyder54]

Hi,

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

[Abraxis49]

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

Significant comorbidities

No distant metastases detected with PET/CT imaging (Ferdinandus et al)

[Tall_Allen in reply to Abraxis49]

In the first paragraph is a link to the article that describes when early salvage is required.

[Abraxis49 in reply to Tall_Allen]

Thanks!

[julianc]

"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?

[Tall_Allen in reply to julianc]

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.

[julianc in reply to Tall_Allen]

Many thanks. I do fall in those categories, but was sure I'd read that should start SRT when PSA reaches 0.1 ideally and certainly by 0.2, but these levels could still be reached whist having a PSADT of 12+ months.

[Shorehousejam]

This is a great thread to read. Thank you