MSK Nomograph-- strange results-- also GY SRT query

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compiler
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Date Joined Nov 2009
Total Posts : 7205
   Posted 1/8/2011 10:12 AM (GMT -6)   
For those who have undergone SRT, how many GY did they use?
 
When I try the MSK nomograph
 
 
for SRT, I get interesting results.
 
My numbers are: 4.19 PSA
G 4+3
Surg. margins positive'
ECE--YES
Pre-radiotherapy PSA 0.21 (estimate)
PSA doubling time: 3 months
Months disease free: 13
GY: 78
 
I get a 36% roughly probability of 6 -year progression free survival
 
If I change the GY to 66, it goes up to 52%!!!
 
If I lower it, it then goes down.
 
If I go to 72, then the prob. is 45%.
 
Isn't that very strange? I thought the higher the GY was, the better chance you had (with more SE).
 
So, what is the standard GY dose for SRT?
 
Mel

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4229
   Posted 1/8/2011 10:20 AM (GMT -6)   
Mel,
This was discussed a while back. What happens in certain situations in the nomograms is that the sample size for that particular set of stats is too low and one abberation can influence the result. In just about 100% of the time a higher dose will equate to a higher cure rate, not a lower one.
JohnT
65 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, no side affects and psa .1 at 1.5 years.

James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4462
   Posted 1/8/2011 10:44 AM (GMT -6)   
Mine plans to do 66GY's over 7 1/2 weeks..
James C. Age 63
Gonna Make Myself A Better Man tinyurl.com/28e8qcg
4/07: PSA 7.6, 7/07 Biopsy: 3 of 16 PCa, 5% involved, left lobe, GS6
9/07: Nerve Sparing open RP, Path: pT2c, 110 gms., clear except:
Probable microscopic involvement-left apical margin -GS6
3 Years: PSA's .04 each test until 04/10-.06, 09/10-.09, 01/11-.09
ED-total-Bimix 30cc

compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7205
   Posted 1/8/2011 12:24 PM (GMT -6)   
John:
 
The question is: which one is the aberration?
 
I suspect the 78gy is, since most of the lower ones result in similar probabilities.
 
Still... supposedly they are dealing with so many cases...
 
Mel

dsmc
Regular Member


Date Joined Jul 2008
Total Posts : 149
   Posted 1/8/2011 1:13 PM (GMT -6)   
Hi Mel
I did a total of 68 gy. I am sorry you have to even make any kind of decision on this.
Mine is working well so far as I got another <0.04 for my Dec. psa which was @ the 2 year mark.

I also have a good friend who finished his SRT in Nov. He just got his 1st reading which was 0.3, but he started SRT with over 0.50, so he is happy it is going in the right direction. His surgery was 9 years ago by Dr. William J. Catalona

Good luck with all this!!

David
Age 55
Pre-op PSA 4.3
Surgery Feb. 17 2005
Post-op Path : Gleason 3+3=6
Right pelvic lymph nodes: negative for metastatic carcinoma
Left pelvic lymph nodes: negative for metastatic carcinoma
extent: right lobe 40% left lobe 10%
capsular penetration: Absent
Seminal vesicles and vasa differentia: Uninvolved
Prostate: 26 grams
Post-op PSA's <0.04 for 3 years
Feb. 08: 0.07, March 08: 0.08, June 08: 0.09 and Sept. 08: 0.1
IGRT scheduled.....November 17th....
FINISHED 01/14/09
05/14/09
1st PSA after SRT <0.04
12/03/09
2nd PSA after SRT <0.04
06/03/10
3rd PSA after SRT <0.04

Sonny3
Veteran Member


Date Joined Aug 2009
Total Posts : 2447
   Posted 1/8/2011 3:16 PM (GMT -6)   
Mel, mine was 70Gy delivered over 35 treatments.

Don't know about the nomo numbers. Tried using the thing a few times and figured stats are stats. Didn't like what the danged thing had to say anyway. And I have personally blown away the success stats of one of the top five daVinci dudes in the country.

Every day there is a post here that continues to show that every single PCa case is different and responds different.

Just look at my stats. never got low PSA after surgery. MET discovered only 8 months following surgery and and 3 months following SRT. Now my PSA is 3.9 and I feel better than I have in the last two years. Peeing like a 20 yr old, ED is showing real strong signs of improvement and my energy level and enthusiasm for doing things is off the chart.

I promise I am not sticking my head in the sand about the seriousness of this thing, but I just can't seem to keep wasting anymore energy on it.

Bless you my brother and I hope things work out real well for you.

Sonny
60 years old - PSA 11/07 3.0 PSA 5/09 6.4
da Vinci 9/17/09
Post Surgery Pathology: GS 4+3=7
Stage: T3a
Tumor Volume 12.5% positive margin, extra-prostatic extension
30 day PSA 0.4, 50 day psa 0.53, 64 day psa 0.6
IMRT completed 1/15/10 35 treatments- 70Gy
2/23/10 Post IMRT PSA 1.0
3/22/10 PSA 1.5
4/19/10 PSA 1.2
5/22/10 PSA 1.3
8/9/10 Completed Radiation for MET
9/7/10 PSA 2.2
1/5/11 PSA 3.9

compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7205
   Posted 1/8/2011 3:41 PM (GMT -6)   

Sonny:

 

You and I had the same surgeon, so we are both blowing away his stats!

 

Mel


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 1/8/2011 3:47 PM (GMT -6)   
Mel:

I was given 72 gys spread over 39 treatments. They had considered 80, which is huge for SRT, so glad they didnt, as the 72 did so much perm. damage to me.

david
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 Not taking it
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/23/10

SubicSquid
Regular Member


Date Joined Oct 2009
Total Posts : 252
   Posted 1/8/2011 4:07 PM (GMT -6)   
Mine was 70 gys over 39 treatments. Squid.
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