adjuvant and salvage

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lewvino
Regular Member


Date Joined Jul 2009
Total Posts : 384
   Posted 8/27/2009 5:24 AM (GMT -6)   
What is the difference between adjuvant and salvage radiation?
 
 
Age at diagnosis 54, PSA 5.1
Father treated for Prostate Cancer in 1997 with Proton Beam - Still doing well.
My Stats
Biopsy 04/08 12 cores, 5 positive
Gleason 3 Cores at 4+3=7, 2 Cores at 3+4=7
Perineural Invasion Noted on biopsy

Robotic surgery 08/12/09 at Vanderbilt, Nashville TN. 
 
Post Surgery - Dr. Spared 100% of Nerves on the left side.
Estimated that 50 - 70% of the nerves were spared on the right side.
 
Final Path report
20% of the prostate Invovled
Tumor graded at T2C
Overall Gleason 3+4 (7)
Lymph Glands Clear
Positive Margin 1.8 cm in length Noted in Right Apex


hangin-in
Regular Member


Date Joined Sep 2008
Total Posts : 78
   Posted 8/27/2009 5:38 AM (GMT -6)   

Adjuvant is when radiation is done as part of the first treatment plan alongside surgery. Salvage radiation is done when there is a future biochemical recurrence with a rise in PSA after surgery.

I too had a positive apical margin. In my case the Dr did not recomment adjuvant radiation. My PSA was 6 and I had a microscopic margin.

Whether to start radiation immediately (adjuvant) or wait for a rise in PSA (salvage) is a tough decision. I wish you all the best.


Rising PSA 12/06=1.6 12/07=2.1 5/08=2.6
Biopsy 6/4/08 12 core 4 Positive 15%,15%,8%,3%
Diagnose @ Age 51 Gleason 3+3=6
Bone & Cat Scans Normal
Lapro Surgery 8/18/08 at Memorial Sloan Kettering
Pathology report stage T2c organ confined with positive apical margin Gleason 3+3 = 6 (with tertiary grade 4)
Catheter removed 8/26 - reinserted 8/29 - removed 9/2
No continence or potency problems from the get-go.
First post op PSA 10/2/08  < 0.05
2nd  post op PSA 12/30/08 < 0.05
3rd  post op PSA 3/30/09 < 0.01
4th  post op PSA 6/25/09  0.01


Pelahatchie
Regular Member


Date Joined Jul 2007
Total Posts : 86
   Posted 8/27/2009 7:10 AM (GMT -6)   
Generally the time at which the treatment is given but that has been blurred by the ultra sensitive psa test which allows trends to be spotted early and salvage treatment to commence 2 plus years after surgery but at psa levels less than the standard set for recurrence.  So is it adjuvant or salvage if you are two years out from surgery but your psa is .1 I don't know and I don't think it really matters.  Just my thoughts.
Age 45 at DX
 
DX 8/05 Gleason 5, Mayo clinic Second Opinion Gleason 6, PSA 2.8
 
Da Vinci surgery Dr. Dasari, Centennial Nashville 9/24/05
 
Pathology Report Gleason 6, 15 % on left side only very near to the edge of capsule, too close to call on margins, doc's said to watch it very closely, final decision T2A
 
PSA's have basically ranged from <.04 to .05 for two years.
 
no E.D. and no Incontinence, feel very blessed
 
PSA Nov 07 = .06
 
PSA Dec 10th 07 =.07
 
PSA Jan 4th 2008= .1
 
Started Guided IMRT on January 7th, 2008 to treat prostate bed and lymph nodes, completed on March 6th, 2008
 
PSA April 18th 2008 =.03
 
PSA August 18th 2008 = .01 or less, test only goes down to .01
 
PSA August 21st 2009 = .01 or less
 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 8/27/2009 7:15 AM (GMT -6)   
Adjuvant is usually part of the one's primary treatment, whereby the patient has surgery first, then has radiation as soon as healing from the surgery makes its possible. The older definition states that adjuvant is within 6 months of surgery, and salvage radiation is six months month or more beyond surgery.

David in SC
 Age 57, 56 at DX, PSA 7/7 5.8, 7/8 12.3,9/8 14.5
3rd Biopsy Sept 08: Positive 7 of 7 cores, 40-90%, Gleason 7, 4+3
Open RP surgery 11/14/8, Right nerves spared, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
 Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsule, one post. margin, clear lymph nodes 
2009 PSA   2/9 .05, 5/9 .10, 6/9 .11, 8/9 .16
Lastest 7/13 met with Rad. Oncl, considering options, 7/20 Catheter #6 after complete blockage, 8/14 met with Rad Oncl, 8/18 - laser scope surgery to clear blockage, now on Cath #7, 8/26 - cath removed
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 


geezer99
Veteran Member


Date Joined Apr 2009
Total Posts : 990
   Posted 8/27/2009 7:48 AM (GMT -6)   
My uro said that he no longer does adjuvant except in very rare cases. His view is that going immediately to radiation exposes too many to unneeded treatment, while delaying and watching PSA levels seems to introduce little extra risk.
Age at diagnosis 66, PSA 5.5
Biopsy 12/08 12 cores, 8 positive
Gleason 3+4=7
CAT scan, Bone scan 1/09 both negative.

Robotic surgery 03/03/09 Catheter Out 03/08/09
Pathology: Lymph nodes & Seminal vesicles negative
Margins positive, Capsular penetration extensive Gleason 4+3=7
6 weeks: 1 pad/day, 1 pad/night -- mostly dry at night.
10 weeks: no pad at night -- slight leakage day/1 pad.
3 mo. PSA 0.0 - now light pads


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 8/27/2009 9:04 AM (GMT -6)   
geezer, that has been my uro's opinion from the start. surgery, then wait and watch, and radiate if needed
 Age 57, 56 at DX, PSA 7/7 5.8, 7/8 12.3,9/8 14.5
3rd Biopsy Sept 08: Positive 7 of 7 cores, 40-90%, Gleason 7, 4+3
Open RP surgery 11/14/8, Right nerves spared, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
 Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsule, one post. margin, clear lymph nodes 
2009 PSA   2/9 .05, 5/9 .10, 6/9 .11, 8/9 .16
Lastest 7/13 met with Rad. Oncl, considering options, 7/20 Catheter #6 after complete blockage, 8/14 met with Rad Oncl, 8/18 - laser scope surgery to clear blockage, now on Cath #7, 8/26 - cath removed
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

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