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Research re Adjuvent or Salvage treatment

User
Posted 17 Dec 2015 at 21:45
Just doing a bit of browsing and came across this. Hope its useful but take note it was just a small study

Hope the link works but won't know till the mods have processed

http://www.medscape.com/viewarticle/849319

I see the link takes you to a site where you have to sign in so.ive copied the text below

Men who had PSA relapse after salvage therapy had a median overall survival of nearly 14 years.

Salvage radiation therapy (SRT) given after radical prostatectomy may improve outcomes in prostate cancer (PCa) patients, even in those who fail the treatment, according to study findings presented at the 56th annual meeting of the American Society for Radiation Oncology in San Francisco.

The study, led by radiation oncologist D. Nathan Kim, MD, PhD, Claus Roehrborn MD, and Yair Lotan MD, of the University of Texas Southwestern Medical Center in Dallas, included 61 PCa patients treated with SRT following radical prostatectomy (RP) from 1992 to 2000. The objective was to characterize the outcomes of those who failed SRT.

The median post-SRT follow-up was 126 months, during which 26 patients (42.6%) died, 10 (16.4%) from PCa.  Of the 61 patients, 34 (56%) had PSA failure after SRT. These patients had a median follow-up of 157.5 months, during which 68% received androgen deprivation therapy (ADT). The median time from biochemical recurrence to initiating ADT was 48 months. The median overall survival was 13.6 years.

Dr. Kim's group divided the patients who failed into 2 groups: those who failed within 1 year of SRT and those who failed more than 1 year after SRT. Compared with patients who failed SRT more than a year after treatment, those who failed within 1 year of treatment were 10.6 times more likely to die from PCa, 5.7 times more likely to die from any cause, 7.7 times more likely to develop distance metastases, and 8.9 times more likely to develop castration-resistant cancer at 10 years.

The authors concluded that their study supports previously published clinicopathologic parameters for predicting outcomes after SRT even after long-term follow up. It also supports a long lasting survival benefit of early SRT at a lower PSA level, and suggests that SRT is effective in preventing prostate cancer-specific mortality and a low rate of distant metastasis.

Patients with early PSA failure after SRT may represent a more aggressive subgroup that needs close follow-up and further improvement of therapy, the researchers noted.

The researchers defined PSA failure as 2 consecutive PSA rises 0.2 ng/mL or greater above nadir, a PSA rise of 2 ng/mL above nadir, initiation of systemic therapy, or clinical recurrence.

The study was limited by its small sample size and retrospective design, but it is one of the longest follow-up experiences reported for SRT. The study findings are an important addition to the literature, which has a paucity of prospective data on the subject, according to the investigators.

Edited by member 19 Dec 2015 at 11:55  | Reason: Not specified

User
Posted 19 Dec 2015 at 14:59


Hi Bri,

Thanks for that, as I am in the situation of having had SRT, it is of interest to me.

Regrets is perhaps too strong a word but I have two reservations about my SRT.

When my post RP PSA started to climb, 0.2, 0.3 and so on, the urologist kept saying that it was too soon to send me for SRT stating that the RT oncologists would regard it as too early and not accept me for SRT. That may have been true of course, but our local RT unit was working to full capacity and the delay might reflect that; or else it may have been another example of the urol man and the onco man not singing from the same hymn sheet. In the end, I didn't get SRT until I was 0.6

Secondly, I wish I had had a PET scan before SRT, a PET scan after SRT showed a pelvic lymph node spread. Perhaps if known, the SRT could have addressed that too.

Doesn't bother me that much but it may be something that someone heading down that route might consider pushing for.

Dave

Not "Why Me?" but "Why Not Me"?
User
Posted 19 Dec 2015 at 18:21

Dave and Chris,

I think the consultants are on a learning curve and some accept and incorporate findings more quickly than others. Clearly care has to be exercised as sometimes the conclusions of small scale studies are subsequently refuted by later studies. But as regards advanced MRI's enhanced by Choline etc., these are still rare so the number of patients who can benefit is small and this development has been a fairly recent one anyway. Sometimes there can be a strong uptake of Choline which leads radiologists to believe the scan shows cancer in one or more areas, even with a sub 2 PSA but in other cases it is not clear from where the PSA is coming, even with PSA's that are rather higher. MRI's are likely to improve as have the means of delivering RT. You will recall that Roy had an even more advanced MRI scan in Germany and the PSMA scan has recently been introduced by UCLH for limited cases as it has specific advantage for PCa.

 

Edited by member 19 Dec 2015 at 18:21  | Reason: Not specified

Barry
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User
Posted 19 Dec 2015 at 13:04

Just bumping this up.as I have added the text

Bri

User
Posted 19 Dec 2015 at 14:59


Hi Bri,

Thanks for that, as I am in the situation of having had SRT, it is of interest to me.

Regrets is perhaps too strong a word but I have two reservations about my SRT.

When my post RP PSA started to climb, 0.2, 0.3 and so on, the urologist kept saying that it was too soon to send me for SRT stating that the RT oncologists would regard it as too early and not accept me for SRT. That may have been true of course, but our local RT unit was working to full capacity and the delay might reflect that; or else it may have been another example of the urol man and the onco man not singing from the same hymn sheet. In the end, I didn't get SRT until I was 0.6

Secondly, I wish I had had a PET scan before SRT, a PET scan after SRT showed a pelvic lymph node spread. Perhaps if known, the SRT could have addressed that too.

Doesn't bother me that much but it may be something that someone heading down that route might consider pushing for.

Dave

Not "Why Me?" but "Why Not Me"?
User
Posted 19 Dec 2015 at 16:03

Good point about the scan prior to SRT Dave

Bri

User
Posted 19 Dec 2015 at 16:38

Thanks Dave
I'm having SRT in April probably , my post-op PSA being 1.5 and 2.4 four weeks later.. I had a Choline-PET when my PSA was approx. 2.2 but it showed nothing. Apparently Choline is only really effective at PSA 3 or more , but others may dispute that !! Ive only really been offered SRT to stop it coming back in my bladder although they suspect spread that cant be seen. I'm in a positive phase at the moment -- everything to live for , ED or not .
Best xmas wishes
Chris

User
Posted 19 Dec 2015 at 17:23

Oh God - that's even worse than the data I had previously read :-(

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 19 Dec 2015 at 17:38

:-((
Of all the people I'm wishing you both luck
Mine came back at 91% chance of recurrence in 2 yrs , and 95% chance in 5 yrs , which is silly really as its already recurrent !
Then it says 87% chance of survival over 15 yrs . Don't understand . Don't actually care tbh , but would rather not have 15 yrs being ill .

User
Posted 19 Dec 2015 at 18:21

Dave and Chris,

I think the consultants are on a learning curve and some accept and incorporate findings more quickly than others. Clearly care has to be exercised as sometimes the conclusions of small scale studies are subsequently refuted by later studies. But as regards advanced MRI's enhanced by Choline etc., these are still rare so the number of patients who can benefit is small and this development has been a fairly recent one anyway. Sometimes there can be a strong uptake of Choline which leads radiologists to believe the scan shows cancer in one or more areas, even with a sub 2 PSA but in other cases it is not clear from where the PSA is coming, even with PSA's that are rather higher. MRI's are likely to improve as have the means of delivering RT. You will recall that Roy had an even more advanced MRI scan in Germany and the PSMA scan has recently been introduced by UCLH for limited cases as it has specific advantage for PCa.

 

Edited by member 19 Dec 2015 at 18:21  | Reason: Not specified

Barry
User
Posted 19 Dec 2015 at 22:16
Originally Posted by: Online Community Member

Oh God - that's even worse than the data I had previously read :-(

Lyn my post wasn't intended to cause any upset

Bri x

User
Posted 20 Dec 2015 at 02:31

💪 I am rather tougher than that Bri

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 20 Dec 2015 at 03:20

This is interesting. Glad I am back on the site as there is so much information to share and it makes for better medical care when one goes for consults well informed. Georgina

User
Posted 20 Dec 2015 at 07:46

Hi Barry
Does one ask his Oncologist if he can be recommended for a PSMA scan at UCLH , having already qualified for Choline -PET at Oxford and PSA levels unidentified ?? Is that how the system can work ?
Regards Chris

Edited by member 20 Dec 2015 at 07:47  | Reason: Not specified

 
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