Yet another study shows importance of not dallying before salvage radiation

 Getting started early with salvage radiation improves the odds of success, yet another study shows. In this study, an important PSA cutpoint was shown to be 0.25 ng/ml:

"In a study reported in the Journal of Clinical Oncology, Derya Tilki, MD, and colleagues identified a prostate-specific antigen (PSA) level cutpoint, above which initiation of salvage radiation therapy after radical prostatectomy was associated with an increased risk of all-cause mortality in patients with prostate cancer."  Source: The ASCO Post, March 7, 2023. https://ascopost.com/news/march-2023/psa-level-at-time-of-salvage-radiation-therapy-after-radical-prostatectomy-and-risk-of-all-cause-mortality/

In my case, because my urologist wasn't watching me like a hawk, and because Christmas and New Year's hit at the time I was trying to make appointments, I started SRT much later than 0.25.  I was fortunate that it still worked, and apparently cured my cancer.

Latest Salvage Radiation News

 Some recent discoveries in salvage radiation

Early salvage RT after prostatectomy improves outcomes: https://www.cancertherapyadvisor.com/home/news/conference-coverage/american-society-of-clinical-oncology-genitourinary-asco-gu/asco-gu-2022/early-salvage-radiation-after-surgery-improves-mfs-in-recurrent-prostate-cancer/  (Research continues to confirm that earlier is better if you need SRT.)

When to Add ADT to Early or Late Salvage Radiation: https://www.urotoday.com/video-lectures/prostate-cancer-genomic-classifier/video/2269-when-to-add-adt-to-early-or-late-salvage-radiation-dan-spratt.html (I didn't have ADT, otherwise known as hormone therapy, but in higher-risk cases it makes sense)

Salvage Radiotherapy versus Observation for Biochemical Recurrence: https://pubmed.ncbi.nlm.nih.gov/35159007/. (Salvage radiation was associated with better long-term survival, both in terms of being free of metastatic disease and overall survival.)

Salvage Radiation Nomogram Updated

This is exciting stuff for people contemplating salvage radiation after prostatectomy.

https://consultqd.clevelandclinic.org/2015/10/updated-nomogram-predicts-modern-outcomes-after-salvage-radiotherapy-following-radical-prostatectomy/

"A contemporary update of a 2007 predictive nomogram for salvage radiotherapy after radical prostatectomy offers a modernized forecast of cure compared to its predecessor."

"The updated 2016 nomogram takes into account the more recent trend of treating patients at lower PSA levels than in the past (“early SRT”). Randomized trials published since the original nomogram was created have demonstrated the benefit of early SRT in high-risk patients."

Various things on my mind..

It's Halloween. Here's hoping you have more treats than tricks this year.

My PSA 9 years, one month after salvage radiation (SRT) ended, is still less than 0.1.  I had an employer health screen earlier this month and checked it.

In the meantime, I have developed heart palpitations (preventricular contractions), a murmur (mitral valve prolapse) and right bundle branch block. None of these are currently dangerous in my case, according to my cardiologist, but they have my attention.  They're a reminder that despite apparently beating prostate cancer, I'm still mortal, still in late middle age, and one day the Reaper will come mowing for me.

Here's a question that I once asked, and I see asked all the time on discussion boards like HealingWell and CancerForums.net:

"I had a prostatectomy x years ago, and now my PSA is rising.  It's at 0.4, up from 0.1 a few months ago.  Should I get radiation? I hear there's only a 50/50 chance it will work."

Well, how old are you?  That's a key question.  If you're 85, you may well want to skip radiation, see how your PSA tracks, and look into hormone therapy if things progress far enough.  If you're 45, I would run, not walk, to the best radiation oncologist I could find.  The reason is that if you're young enough for prostate cancer to progress and kill you, you need to pursue a cure.  Hormone therapy (ADT) won't cure you. If you're elderly, it might be as good as a cure, but if you're young, it's only going to--maybe--stall the cancer.  A 50/50 chance?  It's more nuanced than that, if you want to look into nomograms. Most people don't.  When you get prostate cancer under 50, your youth is a double-edged sword. You will heal faster from treatment, but you have decades for it to come back and...BOO! get you. 

These days, compared to when I was treated, there is a chance you can locate mets with a sensitive scan, and attack those spots specifically. But your PSA has to advance significantly first, and the higher your PSA before salvage radiation, the lower your chances for success (google Andrew Stephenson and salvage radiation outcome).  

Sometimes a layperson or even a doctor will advise the patient that they can wait until PSA gets to something like 2.0 ng/ml.  But that's not wise.  (Again, look up what Andrew Stephenson at Cleveland Clinic found out in long-range studies).  

So if you're a young guy, say, 50 or younger, and you are diagnosed with prostate cancer, my nonprofessional advice to you is to strongly consider a treatment with a known track record, like surgery.  It seems to have a slight edge in long term success for younger patients--less so with older ones.  And, youngster, if your PSA starts climbing after surgery, look into salvage radiation and don't delay. 

If you've had a prostatectomy, salvage radiation is probably going to be a walk in the park. So don't get overly anxious about it. It's a painless, easy treatment. If you have side effects, they'll probably be mild and temporary.  There's no guarantee it will work, but let's say your chances are 50/50.  Isn't that better than zero?  With any luck, you'll be like me, looking forward to some spectacular cardiopulmonary event to shuffle off the mortal coil.

Cue Haunted Mansion music.  (It's Halloween, after all).

My PSA remains less than 0.1.
It was 8 years ago now that I was going to the hospital every morning, Monday through Friday, and laying down while the invisible X-rays did their magic. It was hard to believe something was actually happening to the cancer cells deep inside. But it was!  It was!

Latest Salvage Radiation News

A small study indicates PSA doubling time of 6 months or less is predictive of failure after SRT.

http://informahealthcare.com/doi/abs/10.3109/21681805.2014.982168

Latest Salvage Radiation News:

"For the study, 388 patients with pT3-4pN0 prostate cancer with positive or negative surgical margins were recruited. After RP, 307 men achieved an undetectable PSA (arms A + B). In 78 patients the PSA remained above thresholds (median 0.6, range 0.05-5.6 ng/mL). Of the latter, 74 consented to receive 66 Gy to the prostate bed, and SRT was applied at a median of 86 days after RP. Clinical relapse-free survival, metastasis-free survival, and overall survival were determined by the Kaplan-Meier method.RESULTS:
Patients with persisting PSA after RP had higher preoperative PSA values, higher tumor stages, higher Gleason scores, and more positive surgical margins than did patients in arms A + B. For the 74 patients, the 10-year clinical relapse-free survival rate was 63%. Forty-three men had hormone therapy; 12 experienced distant metastases; 23 patients died. Compared with men who did achieve an undetectable PSA, the arm-C patients fared significantly worse, with a 10-year metastasis-free survival of 67% versus 83% and overall survival of 68% versus 84%, respectively."

http://www.ncbi.nlm.nih.gov/pubmed/25445556

Latest Salvage Radiation News

Freie Universität Berlin (Wikimedia Commons)

Researchers in Germany have completed a followup study on 151 patients. The median followup time was 82 months.
They found a 55% recurrence rate in salvage radiation (SRT) patients. This confirms several other studies around the world that show in the long term, most salvage radiation patients will show at least biochemical recurrence. (In the short run, it's just the opposite) . However, the study also showed very few prostate cancer deaths during the followup period. And the study confirmed other research since 2004: pre-SRT PSA level is a critical factor in predicting the outcome of salvage radiation.  The lower your PSA at the time of salvage radiation, the better.  The takeaway? If you're considering salvage radiation, don't dally.

Lohm G, Lütcke J, Jamil B, Höcht S, Neumann K, Hinkelbein W, Wiegel T, Bottke
D. Salvage radiotherapy in patients with prostate cancer and biochemical relapse 
after radical prostatectomy : Long-term follow-up of a single-center survey.
Strahlenther Onkol. 2014 Feb 28. [Epub ahead of print] PubMed PMID: 24577132.