Defn. of Adjuvent Radiation

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compiler
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Date Joined Nov 2009
Total Posts : 7270
   Posted 1/26/2011 4:34 PM (GMT -6)   
On my last visit to Ford, I was disappointed that the regular doctor I usually see (on Dr. Menon's Team) is no longer there. He moved to Miami!
 
Anyway, I was not impressed with the new guy I saw. Very young, in training, and just didn't seem that knowledgeable.
 
Anyway, when talking about the possibility of SRT, he kept calling it adjuvent radiation and I kept correcting him.
 
He said that if I start radiation before the official BCR (ie; before it gets to 0.2 and confirmed by a subsequent PSA as per AUA guidelines), then it is considered ART. Now, I realize it doesn't really matter what we call it, but I thought ART is when we start radiation immediately and don't wait for a reoccurrence. In other words, the INTENT is the determining factor. I also thought that ART by definition is done within a year of surgery.
 
Again, I'm not sure and neither was this doctor.
 
So, can anyone shed light on the technical definition of adjuvent radiation?
 
Incidentally, tomorrow is my first anniversary of my surgery. Why do I not feel like celebrating?
 
Mel
PSA-- 3/08--2.90; 8/09--4.01; 11/09--4.19 (PSAf: 24%), PCA3 =75 .
Biopsy 11/30/09. Gleason 4+3. Stage: T1C. Current Age: 64
Surgery: Dr. Menon @Ford Hospital, 1/26/10.
Pathology Report: G 4+3. Nodes: Clear. PNI: yes. SVI: No. EPE: yes. Pos. Margin: Yes-- focal-- 1 spot .5mm. 100% continent by 3/10. ED- in progress. PSA on 3/10/10-: 0.01. PSA on 6/21/10--0.02. 9/21/10--0.06; 1/4/11-0.13 CRAP!

142
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Date Joined Jan 2010
Total Posts : 7089
   Posted 1/26/2011 4:48 PM (GMT -6)   
I understand Adjuvant to mean before there is BCR, Salvage is after. Walsh's book does not put a "within" time period, only that adjuvant is done before there is evidence of return of cancer  (glossary, p.537)
 
The Cleveland Clinic Guide does not mention adjuvant, only salvage.

Post Edited (142) : 1/26/2011 2:51:17 PM (GMT-7)


Jerry L.
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Date Joined Feb 2010
Total Posts : 3072
   Posted 1/26/2011 5:15 PM (GMT -6)   
Mel,

Neoadjuvant - treatment given before primary therapy.

Adjuvant - treatment given after primary therapy.

Salvage - treatment for a rising PSA.

The main difference is that AR is done without waiting for signs of recurrence, while SR happens after a rising PSA. I don't think there is a magic time period to call it one thing over the other.

It's semantics. Let's call it radiation.

I'm in the same boat with HT. I may be starting that without PSA rising. What do we call this? Adjuvant HT? Crazy?

One year from surgery...you should celebrate...that was a long, hard year I'm sure.

Jerry L.
Nov. 2009 Dx at Age 44
Dec. 2009 DaVinci Robotic Surgery
Jan. 2010 T3b, Gleason 9
Feb. 2010 Adjuvant Radiation

PSA History:
-----------------
Nov. 2009 4.30
Feb. 2010 <.05
May 2010 <.05
Aug. 2010 <.05
Nov. 2010 <.05

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 1/26/2011 5:24 PM (GMT -6)   
Mel,
The new guy has it right. It does not matter when you take on a prophylactic therapy. But that's what it would be if there is no evidence of recurrence.

Tony
Disease:
Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
RALP ~ 2/17/2007 at the City of Hope near Los Angeles.
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.

Status:
"I beat up this disease and took its lunch money! I am in remission."
I am currently not being treated, but I do have regular oncology visits.
I am the president of an UsTOO chapter in Las Vegas

Blog : www.caringbridge.org/visit/tonycrispino

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25394
   Posted 1/26/2011 6:18 PM (GMT -6)   
The old definition made adjuvant radiation as haven taken place within 6 months of surgery, and after 6 months, as salvage radiation, either with or without BCR
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

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 1/26/2011 6:52 PM (GMT -6)   
David,
To my knowledge, adjuvant therapies are called that as long as they are carried out before disease recurrence regardless of the disease. I think the confusing part comes from various studies conducted in prostate cancer that outline when the therapy is done before 6 months. But that's only for comparison to that particular study. Salvage radiation is done only when a relapse has occurred.

Jerry's definitions look right to me. This is how they will be defined in the MSK nomograms as well...

Tony
Disease:
Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
RALP ~ 2/17/2007 at the City of Hope near Los Angeles.
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.

Status:
"I beat up this disease and took its lunch money! I am in remission."
I am currently not being treated, but I do have regular oncology visits.
I am the president of an UsTOO chapter in Las Vegas

Blog : www.caringbridge.org/visit/tonycrispino

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25394
   Posted 1/26/2011 7:00 PM (GMT -6)   
Just repeating what my original medical oncologist told me more than 10 years ago, Think its really a small point to haggle over.
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

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3895
   Posted 1/26/2011 7:27 PM (GMT -6)   
I wonder what they call mine...Post surgery pathology: Gleason 9, Positive margin. one positive vesicle. Nodes negative..PSA 0.9 at six weeks and eight weeks..

My R-doc said call it anything you want, it's $2100 a day...

Jerry L.
Veteran Member


Date Joined Feb 2010
Total Posts : 3072
   Posted 1/26/2011 7:37 PM (GMT -6)   
That was "fairly" funny!!!

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 1/26/2011 7:49 PM (GMT -6)   
Well said Fairwind.
I like your Rdoc... The good thing about honesty is it makes your story easier to remember...

Tony

goodlife
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Date Joined May 2009
Total Posts : 2692
   Posted 1/26/2011 8:41 PM (GMT -6)   
Mel,

I have been doing some thinking about this topic myself. I am 21 months post op. I was advised by Hussein to do ART within 4 months, but let incontinence take precedence.

As I see small increases in PSA, I have begun investigation into what I am still calling adjuvant, pre BCR. Going to local rad, Cleveland Clinic, and maybe back to Hussein. Will probably go to monthly PSA to check rate.

I hate to pull the trigger, shooting at nothing, but have been studying it. Incidentally, I have read that positive margin guys have some the highest success rates.

I think it is matter of semantics. I am trying to balance the qol issue with longevity, with prudence. If I think I can improve my odds significantly, with minimal qol effects, I will most likely do it based on my G9.

Good luck on your process.

Goodlife

compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7270
   Posted 1/26/2011 8:50 PM (GMT -6)   
Yes, folks, it is all a matter of semantics!
 
Thanks for the responses.
 
If I go to radiation, I still think of it as SRT since I was waiting for the PSA to rise before doing radiation.
 
Mel

142
Forum Moderator


Date Joined Jan 2010
Total Posts : 7089
   Posted 1/26/2011 9:29 PM (GMT -6)   
Mel,
 
If there is any evidence that the cancer is returning, by Walsh's glossary, it is Salvage. So you are on target.
 
Goodlife mentioned Cleveland Clinic, which doesn't even use the term "adjuvant" in their book, only "salvage".
Fairwind never came to an undetectable PSA, so Salvage applies there too. But then maybe they were trying to salvage a little cash.

goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2692
   Posted 1/26/2011 10:35 PM (GMT -6)   
142,

My surgeon who was co~director of CC department would not recommend ART. He said current thinking was to wait for BCR. Not sure he was speaking for CC, but certainly gave me glimpse of some thinking there.

Goodlife
Goodlife
 
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared, but carved up a little.
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks .
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)
5 month PSA <.03 (undetectable)
6 Month PSA <.01
1 pad a day, no progress on ED.  Trimix injection
No pads, 1/1/10,  9 month PSA < .01
1 year psa (364 days) .01
15 month PSA <.01

142
Forum Moderator


Date Joined Jan 2010
Total Posts : 7089
   Posted 1/26/2011 11:11 PM (GMT -6)   
Goodlife -
a great example of the clear medical direction we get - my uro/surgeon believes in the "kill it before it grows" approach, so RT was on the books at the first post-op appointment.

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25394
   Posted 1/26/2011 11:40 PM (GMT -6)   
goodlife, my surgeon was of the same opinion as yours on this subject
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

Jerry L.
Veteran Member


Date Joined Feb 2010
Total Posts : 3072
   Posted 1/27/2011 4:50 PM (GMT -6)   
My doctor(s) were more like 142. At least SR is another bullet when the enemy shows their head.
Nov. 2009 Dx at Age 44
Dec. 2009 DaVinci Robotic Surgery
Jan. 2010 T3b, Gleason 9
Feb. 2010 Adjuvant Radiation

PSA History:
-----------------
Nov. 2009 4.30
Feb. 2010 <.05
May 2010 <.05
Aug. 2010 <.05
Nov. 2010 <.05

goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2692
   Posted 1/27/2011 5:41 PM (GMT -6)   
Jerry,

That is the question. If we "fire away" at the place where we think the enemy might be, and use up our ammo, are we just wasting ammo, messing up the countryside, and spending a lot of money on a whim ?

It seems like they need to find a better diagnostic tecnique that.will allow a scan to identify PC.in smll quanties after rising PSA.

Goodlife
Goodlife
 
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared, but carved up a little.
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks .
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)
5 month PSA <.03 (undetectable)
6 Month PSA <.01
1 pad a day, no progress on ED.  Trimix injection
No pads, 1/1/10,  9 month PSA < .01
1 year psa (364 days) .01
15 month PSA <.01
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