An update to "Even Better Odds"

Earlier, I reported on research by Loeb, et al., on the efficacy of salvage radiation (see "Even Better Odds" below).

It turns out their research really didn't turn up improved odds for me like me--pos. margins and/or extracapsular extension.

I read a more detailed abstract of this on the AUA website. (I've also ordered a full text copy of the article for my own use).

On the AUA site (where they make poster sessions available for free) it says (all caps is my emphasis) "In patients with SM+/ECE, SVI, and LN+, the 7-year progression free survival rates WITH OBSERVATION were 62%, 32%, and 7%, respectively. AMONG THOSE WHO FAILED, 56%, 26%, and 0%, respectively, maintained an undetectable PSA for 5 years after salvage radiotherapy."

Okay. This means--using positive margin patients like me as an example--that 62% did not progress in 7 years of observation. Of the men that DID see their PSA rise during observation (like me), 56% seemed to have a good response to salvage radiation, at least out to 5 years.

So I'm back to post-salvage progression-free odds in the neighborhood of 55-60% again, like Stephenson's research indicates.

The NEW Prostate Cancer Infolink

If you haven't seen this revamped site, drop everything and check it out right now. Tons of good information, and it's watched over and run by medical professionals. My friend John, (aka) az4peaks@newpca.org, is there. John is a real "go-to" guy for information on this disease.
http://prostatecancerinfolink.net

Don't miss out on the social networking aspect of the site. If you want to talk about prostate cancer, it's the place to go.

Look for me (Galileo) there!

Survival Benefit

A preliminary, retrospective study shows that salvage radiation may offer a survival benefit in a subgroup of patients. Looking at two groups--those with PSA doubling times greater than or equal to 6 months, and those with doubling times less than 6 months, both groups did better with salvage radiotherapy than without--BUT--those with relatively fast doubling times had a more pronounced benefit.

Ten-year prostate cancer survival was substantially higher for men given salvage radiotherapy alone or with hormonal therapy than for those who received no salvage therapy (86%, 82%, and 62%, respectively, P<0.0001),>

Trock B, et al "Prostate cancer-specific survival in men with biochemical recurrence after radical prostatectomy: impact of salvage radiotherapy vs. observation" ASCO GU Meeting 2008.
http://www.medpagetoday.com/MeetingCoverage/ASCOGU/dh/8357

Even Better Odds

Eur Urol. 2008 Jul;54(1):88-96. Epub 2008 Apr 1.

Long-Term Rates of Undetectable PSA with Initial Observation and Delayed Salvage Radiotherapy after Radical Prostatectomy.

Loeb S, Roehl KA, Viprakasit DP, Catalona WJ.

Department of Urology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.

PubMed citation:
http://tinyurl.com/4nclog

"The long-term rates of undetectable PSA associated with an SRT strategy were 83% and 50% for men with SM+/ECE and SVI, respectively. In the subset of 716 men who did not receive any hormonal therapy, the corresponding long-term rates of undetectable PSA were 91% and 75%, respectively."


91% long term rate of undetectable PSA. That's music to my ears, since I fall into that statistical group (positive margins, no hormonal treatment).

70 beats 60

"Improved outcomes with higher doses for salvage radiotherapy after prostatectomy." King, CR, and MT Spiotto. International Journal of Radiation, Biology, and Physics. 1 May 2008, 71(1):23-7. http://www.ncbi.nlm.nih.gov/pubmed/18207668

"PURPOSE: To evaluate relapse-free survival with higher doses for patients receiving salvage radiotherapy (RT) after radical prostatectomy (RP). PATIENTS AND METHODS: A total of 122 patients with pathologically negative lymph nodes received salvage RT after RP from 1984 to 2004...CONCLUSIONS: A clinically significant dose response from 60 Gy to 70 Gy was observed in the setting of salvage RT after prostatectomy. A dose of 70 Gy to the prostate bed is recommended to achieve optimal disease-free survival."

Less than 0.1 again

I had blood drawn last week, and just got the news that my PSA was again less than 0.1. Time to celebrate!

Nomogram posted...but with problems

The Memorial Sloan Kettering site http://www.nomograms. org finally posted the salvage radiation treatment nomogram, but it appears to be full of errors. To begin with, the results are listed as progression free after surgery, not SRT. Even if you assume a simple mistake in labeling the results, the nomogram is still wildly different from that published in the original paper format. Hopefully this will get fixed soon. I've sent emails to both MSK and Dr. Stephenson about this.