Encouraging new study on SRT

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Galileo
Veteran Member


Date Joined Nov 2008
Total Posts : 697
   Posted 4/19/2011 1:09 PM (GMT -6)   
A previous study (Trock, JAMA, 2008) indicated that salvage radiation conferred a survival benefit on patients with rapid PSA doubling times.
A new study, in the journal Cancer (March 2011), looking at SRT patients for more than 11 years, showed a significant reduction in all-cause mortality for patients, whether their doubling time was less than or greater than 6 months.
www.ncbi.nlm.nih.gov/pubmed/21437885?s_cid=pubmed
Galileo

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T2c, NX MX, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) Jan-Mar 2007
PSA 9/2007 and thereafter <0.1
pcabefore50.blogspot.com

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 4/19/2011 2:19 PM (GMT -6)   
Galileo,

I am having one of my "literal" moments, so bear with me. Thanks for posting that, its interesting, but doesn't the conclusion contradict itsef?

CONCLUSIONS: Salvage RT for PSA DTs less than or in excess of 6 months is associated with a decreased risk in all-cause mortality

Isn't that saying that there is a decreased risk, is the PSA DT <6 months and >6 months? Isn't that canceling itself out?
Or is saying that SRT regardless of PSA DT is associate with a descreased risk?

It's mute point for me, as my SRT failed in 9 months as did my surgery.

Dazed and confused,

David in SC
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 margin
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, 2/11 1.24, 4/11 3.81
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 9/10

Galileo
Veteran Member


Date Joined Nov 2008
Total Posts : 697
   Posted 4/19/2011 5:09 PM (GMT -6)   
David, I had to read it a couple of times. My translation:

"A few years ago there was a study that showed a survival benefit of SRT, but it was mainly for men with rapid doubling times. Our study showed that there was indeed a survival benefit, but it is for both groups of men--those with doubling times less than 6 months and those with longer doubling times."

In other words, SRT conveys a statistical survival benefit, and it doesn't matter whether the PSADT was < or > than 6 months.

The previous study by Trock had surprised a lot of people, because in the past doctors had thought that rapid PSADT in the post-prostatectomy man was a strong indicator of distant disease, and therefore they might discourage men from SRT. Trock seemed to show that men with rapid doubling times were the ones who benefited the most, and the way most doctors interpreted that was due to the fact that rapid doubling times flagged men who were more likely to die of prostate cancer than with it. (Men with slow doubling times being more likely to live normal lifespans in spite of systemic PCa).

But here comes this new study, that showed at least at Duke, SRT conveys a survival benefit on a much larger group.
Galileo

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T2c, NX MX, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) Jan-Mar 2007
PSA 9/2007 and thereafter <0.1
pcabefore50.blogspot.com

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 4/19/2011 5:17 PM (GMT -6)   
Galileo,
Thanks for the post. In a strange sort of way it goes with the Brosman report on 18.6 post prostatectomy. Menwho had more lymph node dissection had better results even when the nodes were negative for prostate cancer.

I think that the old philosophy of prejudging the efficacy of local therapies in advanced cases is crumbling before our eyes. SRT has far been improved from older data and this means good news for anyone headed that way. Additionally salvage RP is making waves and there are good stories there too.

It funny how at one point a protocol is considered less effective but years later the patients are still standing in better shape than those who skipped it at the professional recomendations of well known doctors.

Tony
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:
Da Vinci Surgery ~ 2/16/2007
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.
Undetectable PSA.

Blog: www.caringbridge.org/visit/tonycrispino

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 4/19/2011 6:05 PM (GMT -6)   
Galileo,

I am not hung up on the report, great info. I think its the way the conclusion in the report reads. Sounds like it would have been easier to read/understand if it simply said that doubling times weren't a factor, and that SRT has an advantage regardless, or something like that. I tend to get hung up on single details sometimes. Don't mind me.

David in SC
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 margin
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, 2/11 1.24, 4/11 3.81
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 9/10
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