fingers crossed, again

Had blood drawn for PSA yesterday.

Patrick Walsh

I checked out the 2007 edition of Dr. Patrick Walsh's Guide to Surviving Prostate Cancer, co-written with Janet Farrar Worthington. This is an excellent, very accessible text and I highly recommend it. My only quibble is that while Walsh revised the section on salvage radiation to include a statement by Danny Song of Johns Hopkins:"Even men with Gleason 8-10 disease, if they had positive margins, a longer PSA doubling time, and received early salvage radiation, were able to attain four-year control rates of 81%," Walsh still ends the chapter with a large, bolded box that says if you have ANY of these things--Gleason 8 or higher, positive seminal vesicles/lymph nodes, PSA recurrence within a year--you're not likely to benefit from radiation! Not only does Walsh contradict Song's statement, but he ignores some landmark 2004 and later research by Andrew Stephenson that shows even if you have a high risk factor like a high Gleason OR fast PSA doubling time, it is very likely you will benefit from radiation as long as it is started before your PSA gets too high.

I'll get blood drawn in the next week or two for my 9 month post-salvage PSA test. I'll go see the doc in early January.

Radiation After Surgery Keeps High-risk Prostate Cancer At Bay

ScienceDaily (Nov. 2, 2007) — An analysis of data involving more than 2,000 patients from 17 U.S. institutions demonstrates that men with high-risk prostate cancer who receive radiation therapy after a prostatectomy were less likely to have a recurrence of disease.

What's more, men whose cancer persists after surgery were less likely to see the cancer spread if they receive radiation (salvage therapy)...

These are the conclusions of a study presented October 30, 2007 at the American Society for Therapeutic Radiology and Oncology's 49th Annual Meeting in Los Angeles.

Citation: Fox Chase Cancer Center (2007, November 2). Radiation After Surgery Keeps High-risk Prostate Cancer At Bay. ScienceDaily.
http://www.sciencedaily.com/releases/2007/10/071030170214.htm

I haven't found any more details on this study, but will post them as soon as I do.

Surgery hikes odds of surviving prostate cancer

(Reuters)
CHICAGO - Men have the best chance of surviving prostate cancer in the long run if the gland is removed, particularly if they are younger or the cancer is aggressive, a study said on Monday....
It found that in the short-term, up to five years, there was little difference in survival among men based on the kind of treatment they received.
But after 10 years, "patients treated with radiotherapy or watchful waiting had a significantly increased risk of death from prostate cancer compared with patients who underwent prostatectomy (removal of the gland)," the study said....
The survival rates after 10 years were 83 percent for removal, 75 percent for radiation, 72 percent for watchful waiting, 41 percent for hormone therapy and 71 percent for other treatment....
http://www.msnbc.msn.com/id/21196506/

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.

fingers crossed

Had blood drawn just now. This is roughly 6 months post-radiation. I'm hoping for it to come back LESS THAN 0.1.

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