they are 50% chance within 3 years,  80% chance within

the bottle of scotch! Hopefully, Curtis, it was a typo!!

Other than for SI+EBRT and RP where a direct comparison, with the same
definition of failure (DOF), can be made, I am unaware of any other work
that shows that RT and RP have similar outcomes when using the same DOF.
Please provide a reference if I've missed something.
============hi ron - the head of indiana university medical division gave a
presention that reflected a simliar number on what i posted.  i was
shocked when first heard these numbers.

i challenge the numbers from I.U but he said they were correct.  i'm
thinking that maybe it is in the wording........OF the ones who get
recurrence of prostate cancer do so in this time frame.

dr. catalona is one of the leading surgeons in the united states and has
very extrensive knowledge of prostate cancer.

this is a response to a questions posed to him and also an article on
radiation.

~ curtis

===================
Q:  TIME TO RECURRENCE AFTER RADICAL PROSTATECTOMY:What is the most
usual time frame for psa evidence of recurrent cancer after a radical
protatectomy? I had heard 18 months is the most common time to see this.
A:   Of men who have recurrence, approximately 50% have it within 3
years, 80% withing 5 years and 99% within 10 years.
===========New Results for Postoperative Radiotherapy
By William J. Catalona, MD  

Several previous articles in QUEST and on the drcatalona.com website
address
postoperative radiotherapy, but recent reports have increased our
knowledge, and
this article supplements those previous ones.

History
In the past, we, and other researchers, analyzed 4-year studies of the
effect of postoperative radiotherapy on recurring prostate cancer after
a radical prostatectomy. The figures looked pretty good, and we
reported, with some optimism, that postoperative radiotherapy worked in
saving lives.
It has become clear from recent studies that some patients are far more
likely to benefit from postoperative radiotherapy than others, depending
upon the particular features of their tumor, their PSA level at the time
of treatment, and the dose and technique of radiotherapy used.
For instance, favorable features would be a low PSA level at the time of
treatment, a more slowly rising PSA level, a lower Gleason grade, and a
higher dose of radiation.
Unfavorable features would be the presence of seminal vesicle invasion,
lymph node metastases, a high and/or rapidly rising PSA, and a high
Gleason grade. The presence of positive surgical margins has been found
to be a favorable feature in some studies but not others.
Also, the duration of follow-up affects the results of postoperative
radiotherapy. With longer follow-up, more patients are found to relapse.
Thus, the results of postoperative radiotherapy are strongly influenced
by the patient mix. In series of patients who are selected with
favorable features, postoperative radiotherapy is more successful than
in those that include patients with unfavorable features. However, many
patients have mixed features.
In the past, some physicians have felt that patients having certain
adverse features such as lymph node metastases, seminal vesicle
invasion, very high Gleason grade, or a persistently detectable or
rapidly rising PSA after surgery should not be treated with
postoperative radiotherapy.
Rather, hormonal therapy would be deemed more appropriate, because these
patients would have a high likelihood of having distant metastases.
Furthermore, to date there is no proof that postoperative radiotherapy
can reduce the ultimate incidence of distant metastases or improve
survival.
Recent studies have shed some new light on this controversial area of
prostate cancer treatment. Although the results differ from study to
study, part of the reason for these differences lie in the types of
patients included, the radiation techniques used, and the length of
follow-up.
Adjuvant and Salvage
Postoperative radiotherapy has two categories: adjuvant and salvage.
Adjuvant is preventive treatment closely following a radical
prostatectomy. It is recommended after surgery reveals adverse
pathologic findings that indicate a likely spread of the cancer beyond
the prostate gland but, at the same time, the patient has an
undetectable PSA.
Salvage radiotherapy is the treatment recommended when, after a RRP and
upon follow-up testing, a patient has a rising PSA. It has been thought
that salvage radiotherapy has the potential to cure patients with cancer
recurrence after radical prostatectomy.
Stephenson Study
A recent journal article, (Stephenson, JAMA 2004) being read by doctors
with a great deal of interest, reported on patients they had followed
for almost four years to watch the effects of postoperative
radiotherapy.
Because doctors are using the information, I think our readers should be
familiar with it.
In that 4-year period, approximately 50% of patients who received
salvage radiotherapy for a rising PSA after radical prostatectomy showed
further cancer progression; 10% developed distant metastases, and 4%
died of prostate cancer.
Factors other than a rising PSA figured into the results. Progression
was more likely to occur in men with a Gleason score of 8 or more, a PSA
level of 2 or higher before radiotherapy, negative surgical margins, a
PSA doubling time of 10 months or less after a RRP, or seminal vesicle
involvement.
The idea that negative surgical margins might be a factor in prostate
cancer progression is a paradoxical finding. The proposed explanation is
that patients with positive margins are more likely to have a tumor
recurrence within the bed of the prostate; whereas, those with negative
margins are more likely to have a distant recurrence. However, I am not
convinced of this explanation, and our data does not confirm it.
Among patients with none of these adverse features present, 77% with a
rising PSA after RRP remained free of cancer progression for 4 years.
And some patients with only one adverse finding fared surprising well.
For instance, 64% of men with a rapid PSA doubling time remained free of
recurrence for 4 years if their Gleason grade was 7 or less and their
surgical margins were positive.
Also, patients with a Gleason score of 8 or higher had a progression
free survival of 81% if they were treated early, had a PSA doubling time
longer than 10 months and positive surgical margins.
Therefore, some patients with high-grade cancer and/or a rapid PSA
doubling times who were previously thought to be destined to develop
metastases may respond well to radiotherapy, at least for a 4-year
period.
If Stephenson is correct, some patients with recurring prostate cancer
can be optimistic that postoperative radiotherapy might, at least,
postpone the spread of CaP.
Longer Study
Recently, my research group (including Dr. Misop Han, Jonathan
Rubenstein, and Kimberly Roehl) updated our results analyzing the
effects of postoperative radiotherapy with a longer follow-up, projected
10-year outcomes.
We found a significant decrease in progression-free rates with these
longer follow-ups. In other words, the postoperative radiotherapy might
not have worked as well as we thought.
In the salvage treatment setting that was recommended because of a
rising PSA, we evaluated 307 patients.
Overall, PSA levels fell to undetectable in 73% of patients after
radiotherapy. We observed favorable responses more often in men without
seminal vesicle invasion and in those with a lower PSA at the time of
treatment.
However, we did not confirm better response rates in men with positive
surgical margins. In this finding, our results conflict with
Stephenson's.
With long-term follow-up, though, only 25% of all patients had lasting
responses to salvage radiotherapy. (The 5-year response rate was 55% and
10-year rate was 35%.) It is important to note, however, that many
patients with long-term follow-up were treated with older radiotherapy
methods that are not as effective as those currently in routine use.
One of our conclusions is that we need more studies to answer an
important question: Is postoperative radiotherapy deterring the spread
of prostate cancer? In other words, how many patients would follow the
same time-line with or without the postoperative radiotherapy?
In patients treated with adjuvant radiotherapy (adverse pathologic
findings but an undetectable PSA), the results were that 78% were free
of recurrence at 5 years and 64% at 10 years. In matched patients who
did not receive adjuvant radiotherapy, 75% were recurrence free at 5
years and 50% at 10 years. Thus, there appears to be a distinct benefit
for adjuvant radiotherapy with long-term follow-up.
Controversies
A current controversy is taking place over whether all men with adverse
pathologic findings after radical prostatectomy should automatically
receive adjuvant radiotherapy if their PSA levels become undetectable
after surgery ,or whether they should follow their PSA levels and
receive radiotherapy only if the PSA begins to increase.
In women with breast cancer, for which there is no sensitive tumor
marker such as PSA; adjuvant radiation and chemotherapy are routinely
given if the surgery reveals adverse findings. Thus, all such women
would be treated as though they would have cancer progression without
further treatment.
However, with prostate cancer, the PSA test provides a sensitive marker
for persistent cancer, and the results of treatment appear to be nearly
as good if the radiotherapy is given when the PSA just begins to rise.
Delaying therapy until the PSA rises can avoid unnecessary treatment in
some patients; however, waiting until the PSA is higher than 2 ng/ml can
compromise results.
Another controversy exists about whether patients with very high-risk
tumors should receive hormonal therapy in conjunction with postoperative
radiotherapy, and, if so, for how long should it be continued.
Studies in patients treated primarily with radiotherapy (without
surgery) have shown that patients with high risk tumors respond better
if they receive hormonal therapy beginning before and continuing for two
years after radiotherapy.
However, it is not known if prolonged hormonal therapy is needed with
salvage radiotherapy. This distinction is important because many men
would prefer to avoid prolonged hormonal therapy with its associated
side effects of hot flashes, sexual dysfunction, and changes in body fat
and muscle distribution. The answer to this controversy is unknown and
these decisions must be made on an individual basis between the patient
and his physician.
Place for Optimism
Relying on postoperative radiotherapy to deter the spread of cancer may
have to be revisited. But, with new and more effective detection
techniques, we might not have to worry about postoperative radiotherapy.
Men will be treated soon enough so that a recurrence of the cancer is
unlikely. And that world is the best of all possible worlds.

knowledge is power - growing old is mandatory - growing wise is optional    
"Many more men die with prostate cancer than of it. Growing old is
invariably fatal. Prostate cancer is only sometimes so."
http://community.webtv.net/PALMER_ENT/doc

Bev...Mustn't there be prostate cells remaining, after all, a non-zero
PSA can be measured after RT.  That being the case, why can't the RT
treatment cause another prostate cancer to emerge somewhere down the
road.  I hadn't really thought about this possibility until Curtis
mentioned it up above, but since RT can cause secondary cancers in the
areas surrounding the prostate, why couldn't it cause a new prostate
cancer to appear in the remaining prostate cells at some later date.
It seems logical, although I've never seen it discussed before.
Perhaps it hasn't been mentioned in the literature because how could
you differentiate a secondary prostate cancer caused by the RT from a
recurrence due to cancerous tissue that wasn't killed by the RT?..Best
wishes and good health, Ron

Bev...Mustn't there be prostate cells remaining, after all, a non-zero
PSA can be measured after RT.  That being the case, why can't the RT
treatment cause another prostate cancer to emerge somewhere down the
road.  I hadn't really thought about this possibility until Curtis
mentioned it up above, but since RT can cause secondary cancers in the
areas surrounding the prostate, why couldn't it cause a new prostate
cancer to appear in the remaining prostate cells at some later date.
It seems logical, although I've never seen it discussed before.
Perhaps it hasn't been mentioned in the literature because how could
you differentiate a secondary prostate cancer caused by the RT from a
recurrence due to cancerous tissue that wasn't killed by the RT?..Best
wishes and good health, Ron