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.)

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

LESS THAN 0.1 !

This is the best possible news. (Note: I had earlier blogged that it was 0.1, but the nurse had misspoken on the phone.)

Before surgery: 4.8 (but really, 9.6 because I was on a medication that artificially lowered it)
3 months after surgery: less than 0.1 (or "undetectable" on the standard assay)
6 months after surgery: 0.2
10 months post surgery: 0.6
Day before radiation started (about 11 months post-surgery): 0.7
IMRT for 8 weeks
3 months post-radiation: 0.1
4.5 months post-radiation: 0.1
and now, 6 months post radiation: < 0.1

I'm clearly in the "complete responders" group Andrew Stephenson has reported on. His study shows 49% of those who got a complete response within 9 months were free from disease progression 6 years later. That may not sound great to you (50-50 odds) but overall rates of success in salvage radiotherapy in the long run are not nearly that high. My odds in the short run are excellent.