Zero point five: a number to remember

Earlier is better when it comes to salvage radiation therapy (SRT) another study reports. This had been clearly identified by Stephenson et al., in the past. This time the study comes from Italy and is reported in European Urology: nearly 3/4 of men who had SRT at PSA levels of 0.5 or lower were alive and  free of biochemical progression nearly 5 years later.  (Being free of biochemical progression basically means undetectable PSA).

So if your PSA has risen after prostatectomy, and you're considering radiation as a second attempt at a cure, time is of the essence. If your doctor says it's okay to wait until you hit 1.0, or, God forbid, 2.0; run, don't walk, to get a second opinion from a radiation oncologist who is more up-to-date on the literature. 

A lot of the time with prostate cancer, time isn't that critical. But with salvage radiation, the clock is ticking.

Another independent validation of the Stephenson nomogram

The nomogram developed by Dr. Andrew Stephenson was independently validated again, last year, by doctors at Loyola University.  The "Stephenson nomogram" predicts the outcome of salvage radiation and is the basis for the interactive tool on the Memorial Sloan Kettering Cancer Center (MSKCC) website.

The researchers followed men for a median of 71 months and found no significant difference between the outcomes for their patients and what the nomogram predicted.  At a median time of 71 months, 46% were progression-free (that is, their PSA had not risen after salvage radiation.)

Salvage Radiation: Nomogram updates

It looks like the Memorial Sloan-Kettering Salvage Radiation Therapy nomogram on Nomograms.org (direct URL: http://www.mskcc.org/applications/nomograms/prostate/SalvageRadiationTherapy.aspx ) has been updated. It's now easier to use and the response makes sense. It used to give your result as post-surgery rather than post-radiation.
I had been thinking that the nomogram was too pessimistic, compared to the paper version. But what I didn't realize was that four months after the paper version was released in the Journal of Clinical Oncology, an erratum was published that corrected a mistake in regards to pre-radiation androgen deprivation (hormonal therapy). The corrected PAPER version of this important tool is here: http://jco.ascopubs.org/content/vol25/issue26/images/large/zlj0150759390003.jpeg ; however, I see no reason to use it because the digital nomogram is much easier, quicker to use, and less prone to human error.

Now both paper and online versions tell me that I've got a 39% chance of being progression free at 6 years. That jibes pretty well with Catalona's research that showed that long term success with prostate salvage radiation is uncommon--only about 25% of patients overall are progression free at 10 years. Of those who had a complete response to radiation, as I did, Catalona found that 35% were free from PSA progression.

The full text of the original article (remember, the nomogram in this original article is not correct) is here: http://jco.ascopubs.org/cgi/content/full/25/15/2035.

If you have a rising PSA after prostatectomy, and you're considering salvage radiation, I encourage you to read the original article and use the online nomogram at Memorial Sloan-Kettering.