Outcome of salvage radiotherapy for biochemical failure

Outcome of salvage radiotherapy for biochemical failure after radical prostatectomy with or without hormonal therapy.

Not sure how I missed this one--probably because I usually search "radiation" and not "radiotherapy"--but a study from MD Anderson in 2005 reaffirmed the idea that the earlier you start, the better, with salvage. Like Stephenson et al at Cleveland Clinic, they found that the best results were obtained when the man's pre-radiation PSA was 0.5 or less.

The MD Anderson study put men into two groups: favorable and unfavorable. Those in the favorable group had pre-RT PSAs of 0.5 or less, and positive margins. Unfavorable included everyone else. 81.7% of those in the favorable group had no PSA progression 5 years later, compared to 61.7% in the unfavorable.

I'm in the unfavorable group. The 61.7% chance of being progression free at 5 years (which would be spring of 2012 for me) matches up well with other research I've read.
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Int J Radiat Oncol Biol Phys. 2005 Sep 1;63(1):134-40.

Outcome of salvage radiotherapy for biochemical failure after radical prostatectomy with or without hormonal therapy.

Cheung R, Kamat AM, de Crevoisier R, Allen PK, Lee AK, Tucker SL, Pisters L, Babaian RJ, Kuban D.

Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA. mrcheung@mdanderson.org

BACKGROUND: This study analyzed the outcome of salvage radiotherapy for biochemical failure after radical prostatectomy (RP). By comparing the outcomes for patients who received RT alone and for those who received combined RT and hormonal therapy, we assessed the potential benefits of hormonal therapy. PATIENTS AND METHODS: This cohort was comprised of 101 patients who received salvage RT between 1990 and 2001 for biochemical failure after RP. Fifty-nine of these patients also received hormone. Margin status (positive vs. negative), extracapsular extension (yes vs. no), seminal vesicle involvement (yes vs. no), pathologic stage, Gleason score, pre-RP PSA, post-RP PSA, pre-RT PSA, hormonal use, radiotherapy dose and technique, RP at M. D. Anderson Cancer Center, and time from RP to salvage RT were analyzed. Statistically significant variables were used to construct prognostic groups. RESULTS: Independent prognostic factors for the RT-alone group were margin status and pre-RT PSA. RP at M. D. Anderson Cancer Center was marginally significant (p = 0.06) in multivariate analysis. Pre-RT PSA was the only significant prognostic factor for the combined-therapy group. We used a combination of margin status and pre-RT PSA to construct a prognostic model for response to the salvage treatment based on the RT group. We identified the favorable group as those patients with positive margin and pre-RT PSA < or =" 0.5" p =" 0.03).">

PMID: 16111581 [PubMed - indexed for MEDLINE]

Characteristics of prostate cancer in men less than 50-year-old

A literature review by French doctors:

Prog Urol. 2009 Dec;19(11):803-9. Epub 2009 Jun 4.

[Characteristics of prostate cancer in men less than 50-year-old.]

[Article in French]

Peyromaure M, Valéri A, Rebillard X, Beuzeboc P, Richaud P, Soulié M, Salomon L;
les membres du CCAFU.

Service d'urologie, hôpital Cochin, 27, rue du Faubourg-Saint-Jacques, 75014
Paris, France.

OBJECTIVE: To report the characteristics of prostate cancer (PCa) in men less
than 50-year-old and the results of different treatments of PCa in this
population. METHOD: A bibliographic research was performed using Pubmed database.
The keywords that we used were: prostate cancer, age, young, radical
prostatectomy, brachytherapy, radiotherapy, active surveillance. The studies
which included a significant number of patients were selected. A total of 38
articles were used as bibliographic references. RESULTS: PCa in young men does
not seem to have different characteristics than in older men. Nevertheless, young
men seem to have a lower risk of severe urinary and sexual sequelae, particularly
following radical prostatectomy. CONCLUSIONS: There is no recommendation
regarding management of PCa in men less than 50-year-old. In case of localized
cancer, two options may be considered. First option consists in decreasing the
urinary and sexual complications of radical prostatectomy. A minimally-invasive
treatment, such as brachytherapy or even active surveillance, may reach this
objective. Second option consists in being more aggressive. To propose a radical
prostatectomy offers to the patient the possibility of salvage radiation therapy
in case of locally-advanced tumor or local recurrence.

PMID: 19945663 [PubMed - in process]

Schrödinger's cat

I don' t see the doctor for a couple of weeks, but I wasn't doing anything this morning, so I figured why not have a stranger stick a needle in the soft inside part of my elbow and let blood run out into a tube. So that's what I did.

I wonder if the phlebotomist thinks, even for a moment, about the role she is playing in the drama of life and death. Does she understand the portent? Perhaps it's better if she doesn't; or else her hands would be shaking so hard she couldn't do the job.

Up until the blood draw, I feel like I don't have prostate cancer anymore. But as soon as it is drawn, and before I get the results, it's like I'm in some kind of no man's land. Either the radiation wiped it out or it didn't. But at this point, I feel like Schrödinger's cat, both alive and dead at the same moment. Or rather, saved and doomed. It's not until I get the results that the probability wave collapses on itself and I become one or the other.

I know, I know. Quantum effects don't hold up in the macro world of people, tumors, and tubes of blood. But that's how it feels.

Sometime late next week, I'll call the nurse and get the result. At that instant, I will either push prostate cancer to the back of my mind and go about life pretty much as I have the past year; or I will start down a path that will quickly lead to the end of my sex life and eventually, the end of life itself.

It's like every 6 months my life path has two forks--two possible doors.



Photo credit: Annie Mole. Used Creative Commons (cc) license. http://www.flickr.com/photos/anniemole/2599914432/

countdown

My next followup with the radiation oncologist is in one month. I'll have blood drawn 7-10 days before that. This will be 3 years since the start of salvage radiation. So far, so good, but it's been six months since my last check.


Looking at the curves in Stephenson's research, at this point about 10% of the patients fall off the curve each year in my group (those who started salvage when their PSA was between 0.51 and 1.0). At two years, 68% were free from progression; at three years 59%, at four years 55%, and at six years, 40%. The good news is, after six years the curve starts to flatten out, although there are still failures happening all the way out to at least ten years.

So I'm by no means safe. I will celebrate another "less than 0.1" reading, certainly, but I won't really start to feel like I'm out of the woods for another 7 or 8 years. With some cancers, there's a huge milestone at the five year mark, but not so with prostate cancer, since it generally moves a lot slower.

Good news on IMRT side effects

No impairment of quality of life 18 months after high-dose intensity-modulated radiotherapy for localized prostate cancer

A German study showing only temporary quality-of-life issues after IMRT (intensity modulated radiation therapy) as a primary treatment. For more information on IMRT, do a keyword search in the custom Google search box (look to the lower right part of this page).

Sunday mornings

Gotta love Sunday mornings. Sleep in, read the newspaper, coffee, relax. Not much to report right now. My next PSA will be in January. The anxiety isn't too bad yet.

This morning I'm reading "The Tao of Chess" and practicing some moves on Gameknot where you can find me playing as Replicannt (note the extra "n"). There are always lots of people to play, the atmosphere (I find) is much more civil than on Yahoo games, and the interface is terrific. If you use the link above and get a premium subscription, I will get a free month, but you can certainly have a lot of fun without paying a dime.

Also trying out some Clic Magnetic reading glasses. They're great, but since you are most likely a man reading this, I would encourage you to get the large size. I bought the regular size and they're almost too small. Otherwise they're a very cool invention. You can see them worn on CSI.

FHLW

Check out the new Faith-Love-Hope-Win website, http://www.flhw.org . FLHW is a non-profit organization that raises money to fight advanced prostate cancer. They deserve the support of the prostate cancer community (hint: order some blue bracelets from them!)