Some information (abstract) on using 'Salvage Radiation-therapy'~comparitive data to analyze

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zufus
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Date Joined Dec 2008
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   Posted 2/20/2009 7:04 PM (GMT -7)   
Some people herein considering 2nd line treatment using radiation for like failed surgery, should have some concept of some of the parameters and knowledge up front before jumping into or signing onto "salvage" radiation. (in this abstract).  I think this was 2007:
 
In the May 20th issue of the Journal of Clinical Oncology, Stephenson and colleagues reported the results of a multi-institutional review attempting to identify which characteristics predict successful treatment with salvage radiotherapy for recurrent prostate cancer after radical prostatectomy. A nomogram was presented to predict the probability of cancer control 6 years after salvage radiotherapy.

A cohort of 1,540 men who received salvage radiotherapy for recurrence after radical prostatectomy was identified from 17 medical centers. PSA recurrence after prostatectomy was defined as a serum PSA of 0.2 ng/ml and rising or a single PSA of 0.5 ng/ml or greater. The variables included in the Cox regression analysis were pre-prostatectomy PSA, Gleason score, extracapsular extension, seminal vesicle invasion, surgical margins, lymph node status, persistently elevated PSA post-RRP, pre-radiotherapy PSA, PSA doubling time, neoadjuvant androgen deprivation and radiation dose.

The probability of remaining free of disease after 6 years was 32% for the entire cohort (95% CI, 28% to 35%), which improved to 48% for patients who received their radiotherapy before their PSA reached 0.6 ng/ml. The most important variables in the model were the serum PSA level before radiotherapy, surgical margin status, use of androgen deprivation before or during radiotherapy and the presence of lymph node metastasis.

This retrospective study with a large cohort of patients treated with salvage radiotherapy after prostatectomy suggests that up to 50% of patients may remain free of disease 6 years after treatment if it is instituted before their serum PSA rises above 0.5 ng/ml. The nomogram proposed predicts with reasonable accuracy which patients are more likely to exhibit a favorable response to salvage radiotherapy and may aid in clinical decision-making,

Stephenson AJ, Scardino PT, Kattan MW, Pisansky TM, Slawin KM, Klein EA, Anscher MS, Michalski JM, Sandler HM, Lin DW, Forman JD, Zelefsky MJ, Kestin LL, Roehrborn CG, Catton CN, DeWeese TL, Liauw SL, Valicenti RK, Kuban DA, Pollack A

J Clin

Of course always look at other data and other abstracts and anything of possible value when assessing your own case and its parameters, issues, uniqueness etc.  Try to verify in effect any claim made on PCa atleast to some degree....never an easy task in this journey. idea   

 

 


 

Post Edited (zufus) : 2/21/2009 4:25:00 PM (GMT-7)


livinadream
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Date Joined Apr 2008
Total Posts : 1382
   Posted 2/20/2009 7:44 PM (GMT -7)   
You are a wise and caring man Bob. How long should someone with my stats expect to have before disease progression? My research indicates a gleason 9 with lymh node involvement can expect recurrence in 24 to 36 months. Any thoughts?

peace and grace
dale
My PSA at diagnosis was 16.3
age 46 (current)
My gleason score from prostate was 4+5=9 and from the lymph nodes was 4+4=8
I had 44 IMRT's
Casodex
Currently on Lupron
I go to The Cancer Treatment Center of America
Married with two kids
latest PSA 5-27-08 0.11
PSA July 24th, 2008 is 0.04
PSA Dec 16th, 2008 is .06
Testosterone keeps rising, the current number is 156, up from 57 in May
cancer in 4 of 6 cores
92%
80%
37%
28%
 


zufus
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Date Joined Dec 2008
Total Posts : 3149
   Posted Yesterday 4:47 AM (GMT -7)   
You are a caring guy Dale and I hope you get whatever benefits can be found from whatever protocol is out there (drugs & combos). If you give me alittle more rope on this question I am sure I could wrap myself up with any kind of opinion (LOL). Only the patient has to walk the walk, not any doctor or spectators, family etc. (they can walk with you or near you) but they don't walk the walk itself.

At the center you are going to although surely a good facility, you might have to determine how regimented are they in using various protocols, are they strictly into a small subset of useable drugs or are they open minded enough (like: Vogelzang, Sartor, Myers, Scholz, Strum, Tucker, Leibowitz, Barken and other leading PCa-oncologists)...whom consider using perhaps all the tools in the arsenal against PCa, but tailor them to their paitents and do switch them around...and may I say with results and many times again and again. Those onco-docs deal with hrpca very often and have found protocols that gain remission atleast for various durations, sometimes they are even astounded by some patients response and/or lack of them too. PCa is more of the Twlight Zone than pure science.

Another school of thought on refractive and/or recurrent PCa (that goes undefeated), some say it makes no difference what you do.....just what we patients wish to hear?????? I tend to believe that the school of thought on that is flawed, probably based upon knowledge and treatments (that were lacking 10-20 yrs. ago or more). Their are many abstracts that show longer or better survival times in patients using protocols e.g. Bolla study (ADT + radiation in certain method too).

Only thing I can say is it is each persons battle, you decide what type of armor you wish to go into battle with and or a plan of attack. Their are garment dressers (LOL) called doctors that offer various types of garments(battle gear) and battle weapons. Kind of like us PCa patients fighting 'predator' it hides, it morphs, it lurks. We are constantly looking for new weapons and some are coming between now and 2010 for FDA approvals in the pipeline. Don't be afraid to look at anything that may work against PCa....it is a choice and somebody, somewhere is trying it....alot of warriors out there that don't give up.

:-) Smile
 


John T
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Date Joined Nov 2008
Total Posts : 4168
   Posted Today 6:01 PM (GMT -7)   
Zufus,
Thanks for the info. I understand that that PSA nadir after radiation is one of the leading indicators of reoccurrance. The lower the nadir the less chance of reoccurrance.
JohnT

I had a psa of 4.4 in 1999 and steadily increasing psa every 3-6 months before reaching 40 in 5-08.Free psa ranged from 16 to 10%

I had biopsies every year, 13 total in all. I saw 5 different doctors, all urologists or urological oncologists at Long Beach, UCLA, UCSF and UCI and had an MRIS at UCSF in 2007. All tests were negative and I was told that because of all the biopsies I most likely didn't have PC, but to keep getting biopsies every year.

in Oct 08 my 13th biopsy of 25 cores indicated 2 positive cores, gleason 3+3 less that 5% in 2 cores. Doc recommended surgery.

2nd opinion from a prostate oncologist, referred by my wife's oncologists said cancer found wis indolant and statistacally insignificant, but PSA histor was a major concern and ordered a few more tests.

Color Doppler ultrasound with targeted biopsy found a transition zone tumor 18mmX16mm, gleason 3+4 and 4+3. CT and bone scans clear, but Doc thinks that there may be lymph node involvement (30% chance) because of my high PSA, and referred me for a Combidex MRI in Holland, currently scheduled for Feb 14.

Changed diet and takiing supplements while I wait. The location of the tumor plus the high psa make surgery an unlikely option. I'm still evaluatiing all treatment options and will make a decision once I get the results of the Combidex scan.

JohnT


zufus
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Date Joined Dec 2008
Total Posts : 3149
   Posted Today 7:09 PM (GMT -7)   
Right on John, I wish my nadir were even lower and longer, and kudos for being the pioneer for Combidex scanning method, I will be mentioning it to others as the comparitive data you have from all the other tests, shows it out performed them big time.
 

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