Salvage Radiation: Nomogram updates

It looks like the Memorial Sloan-Kettering Salvage Radiation Therapy nomogram on Nomograms.org (direct URL: http://www.mskcc.org/applications/nomograms/prostate/SalvageRadiationTherapy.aspx ) has been updated. It's now easier to use and the response makes sense. It used to give your result as post-surgery rather than post-radiation.
I had been thinking that the nomogram was too pessimistic, compared to the paper version. But what I didn't realize was that four months after the paper version was released in the Journal of Clinical Oncology, an erratum was published that corrected a mistake in regards to pre-radiation androgen deprivation (hormonal therapy). The corrected PAPER version of this important tool is here: http://jco.ascopubs.org/content/vol25/issue26/images/large/zlj0150759390003.jpeg ; however, I see no reason to use it because the digital nomogram is much easier, quicker to use, and less prone to human error.

Now both paper and online versions tell me that I've got a 39% chance of being progression free at 6 years. That jibes pretty well with Catalona's research that showed that long term success with prostate salvage radiation is uncommon--only about 25% of patients overall are progression free at 10 years. Of those who had a complete response to radiation, as I did, Catalona found that 35% were free from PSA progression.

The full text of the original article (remember, the nomogram in this original article is not correct) is here: http://jco.ascopubs.org/cgi/content/full/25/15/2035.

If you have a rising PSA after prostatectomy, and you're considering salvage radiation, I encourage you to read the original article and use the online nomogram at Memorial Sloan-Kettering.

FLHW

I just ordered some bracelets from FLHW.org (Faith Love Hope Win), a charity run by David E. David is a guy about my age with advanced prostate cancer. His blog is one of the most compelling pieces of autobiography on the web.

I urge you to visit http://www.FLHW.org, buy a few bracelets, and read David's blog.

I think you'll agree that David is a true hero.

Undetectable PSA and odds of progression after salvage radiation

http://www.oncologystat.com/journals/journal_scans/Achieving_an_Undetectable_PSA_After_Radiotherapy_for_Biochemical_Progression_After_Radical_Prostatectomy_Is_an_Independent_Predictor_of_Biochemical_Outcome_Results_of_a_Retrospective_Study.html

If you achieve an undetectable PSA after salvage radiation, this study shows your odds of being progression free 3.5 years later are 75%. But if your PSA doesn't fall that low, your odds are only 18%.

ha!

From the March 2008 Atlantic Monthly "What's Your Problem?" Q&A column by Jeffrey Goldberg:

Is life after college really as monotonous and depressing as it looks?
--Ben, Manhattan, Kan.

Dear Ben,
No. It's worse! Just kidding. It's actually a joy. Except for the prostate exams.

Good news on PSA once again

Less than 0.1.

A deep sigh of relief. A new lease on life.

With that, as promised, I'm putting this blog to bed. Unless there is really big news in the area of salvage radiation, I don't plan on posting or updating. There is a news feed at the bottom of the page that's automatically populated by news from Google, but I won't be manually adding anything.

And if I hit the mark again on my next PSA, I will probably delete the blog, so that I'm not promulgating obsolete information.

In case you're wondering, YES, we will be celebrating. Magic Kingdom, here we come!

the background picture

The background picture behind the blog title is a shot of the Milky Way I took out in the desert. One of my hobbies is amateur astronomy. I put my old 35mm film camera on a tracking tripod for 3 or 4 minutes.

biography of a prostate

Here's my history, mainly focusing on the time up until salvage radiation began. I was only 38 when we found I had a PSA that was out of range. My uro tried an antibiotic (Cipro) and high dose Motrin with some success. We then tried Avodart in an effort to prevent cancer (chemoprevention) without luck. I had 3 biopsies over the years, and a few urine analyses here and there (urinalysis never found anything).


Age 38
8 Dec 2000
bothered by frequent urination, went to primary care phys.
PSA 4.5
PCP said prostate was boggy
referred to Urologist
Biopsy Ordered

Jan 2001
Biopsy: negative for cancer, findings consistent with prostatitis
Start hytrin for blood pressure control; drug also provides some BPH relief

Age 39
16 Jul 2001
PSA 4.1

20 March 2002
PSA 6.1
START Cipro 500mg daily for 3 wks, Motrin 800 mg daily

Age 40
30 May 2002
PSA 5.7
Free PSA 11.9%
CONTINUE Motrin
Urologist believes probably prostatitis

30 Sep 2002
PSA 7.3
Free PSA 11.3%
START Avodart
STOP Motrin
ORDER Biopsy

November 2002
BIOPSY: negative for cancer, but PIN III found

31 Jan 2003
PSA 2.2
STOP Avodart

Age 41
03 Sep 2003
PSA 4.9
Restart Avodart
Urologist thinks PSA is elevated from BPH

23 Jan 2004
PSA 2.2
Continue Avodart

Age 42
24 July 2004
PSA 2.5
Continue Avodart

26 Jan 2005
PSA 3.3
Continue Avodart

29 Apr 2005
PSA 2.9
Continue Avodart

Age 43
11 Jan 2006
PSA 4.8 (on Avodart)
Abnormal DRE
Biopsy ordered

7 Feb 2006
Biopsy finds cancer
PIN also found
No perineural invasion
Gleason 3+4
20% on right
5% on left

24 Feb 2006
Pre surgical CT scan of pelvis and abdomen, and whole body bone scan. No mets evident. However, it looks like my shoulders are starting to wear out! (Degenerative changes in both AC joints showed up in bone scan). Plus a bulging disk in my spine at L5-S1.


17 March 2006
Pre-surgical chest x-ray is normal.

Age 44
14 April 2006
SURGERY
Robotic prostatectomy
Positive margin at apex and left lobe
No perineural invasion identified
Extension into capsule, but not through
Gleason 3+4
70% of gland involved
Prostate was 22.5 grams
Bundles on both sides were preserved.
stage t2c NX MX

24 April 2006
Catheter out


16 May 2006
PSA less than 0.1

15 Aug 2006
PSA 0.2

14 Dec 2006
PSA 0.6

REFERRED FOR RADIATION

Day before radiation commenced, PSA = 0.7

Radiation Jan-Mar 2007. PSA quickly fell to less than 0.1 and remains there as of late 2016. Note from radiation oncologist to urologist: looks like assumption of local-only recurrence was valid, judging by PSA response.