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Medical Forum / Diseases and Disorders / Prostate Cancer / May 2005Salvage Radiation after RP
If you remember, C. Palmer a few months ago was worried about a PSA rise from .03 to .05, but for his next test, it was down again to .04. I am in a similar situation. My first PSA test 3 months after my RRP was .03. My 2nd test, 6 months later was .07. I am anxiously awaiting my 3rd test in Jun on the one year anniversary of my RRP. My Urologist is concerned, but states that 0.2 is the threshold for recurrence. The good news is the attached report on salvage radiation. I had all negative margins, PSA of 6.6 and Gleason 6. The report shows very good cure rates with salvage radiation, especially if done while PSA is less than 2.0. Hypofractionated radiotherapy as salvage for rising prostate-specific antigen after radical prostatectomy. Lee LW, McBain CA, Swindell R, Wylie JP, Cowan RA, Logue JP. Department of Clinical Oncology, Christie Hospital, Manchester, UK. AIMS: To review the outcome of men receiving hypofractionated salvage radiotherapy for rising prostate-specific antigen (PSA) after radical prostatectomy. MATERIALS AND METHODS: A retrospective analysis of 61 men referred for salvage radiotherapy for biochemical relapse after radical prostatectomy was conducted. Twenty-four men receiving hormonal therapy or with follow-up of less than 12 months were excluded. Thirty-seven men were identified, median age 64 years, median preoperative PSA 11 ng/ml (5.6-60 ng/ml), Gleason scores <7: 70%, Gleason scores > or = 7: 30%. Twenty-seven men had positive surgical resection margins, eight had seminal-vesicle involvement and one had lymph-node involvement. Diagnosis of failure after radical prostatectomy was made on rising PSA in all cases; 19 men also had positive magnetic resonance imaging, 11 abnormal digital rectal examination and nine positive biopsy. Radiotherapy was delivered conformally to the prostatic fossa, 50-52.5 Gy in 20 fractions over 4 weeks. Date of failure after radiotherapy was defined by the American Society for Therapeutic Radiology and Oncology (ASTRO) consensus criteria or as date of commencement of hormonal therapy for rising PSA. RESULTS: Median time from radical prostatectomy to radiotherapy was 30.6 months (8-68 months); median pre-radiotherapy PSA was 2.9 ng/ml (0.5-11.4 ng/ml). PSA response after radiotherapy was seen in 33 out of 37 (89%) patients. At median follow-up of 36 months (20-85 months), 28 out of 37 remained disease-free. Thirteen more patients have had two consecutive PSA rises. Actuarial 3-year disease-free survival is 74%. No patient has developed metastases or died of prostate cancer. Pre-radiotherapy PSA less than 2 ng/ml predicted disease-free survival (P = 0.027). No acute toxicity greater than Radiation Therapy Oncology Group (RTOG) G2 was observed. CONCLUSIONS: Salvage radiotherapy after radical prostatectomy achieved durable biochemical control in most patients. Outcome is improved if radiotherapy is delivered when PSA is less than 2 ng/ml. A policy of close monitoring after radical prostatectomy with early referral for salvage radiotherapy is advocated. PMID: 15630843 [PubMed - indexed for MEDLINE] > If you remember, C. Palmer a few months ago was worried about a PSA > rise from .03 to .05, but for his next test, it was down again to .04. > I am in a similar situation. My first PSA test 3 months after my RRP > was .03. My 2nd test, 6 months later was .07. I am anxiously awaiting > my 3rd test in Jun on the one year anniversary of my RRP. My Urologist > is concerned, but states that 0.2 is the threshold for recurrence. Geez I'm no doctor but those numbers seem awfully low to be worried about? It seems to be in the normal range of error, or statistical variance. Keep us posted.  SignatureJK Sinrod Sinrod Stained Glass Studios www.sinrodstudios.com Coney Island Memories www.sinrodstudios.com/coneymemories hi jim - welcome to the second club you didn't want to join...... when the prostate is removed from the body, all the rules that applied to prostate cancer went with it. now, we are playing with low numbers and it becomes life and death situations when the number is what many consider way below normal. your psa rising is definitely an alarm going off. the kicker to your situation is your stats. you shouldn't be having this type of psa rise. but when you talk with your surgeon, ask him if he got ALL the prostate out of the body and see what kind of an answer he gives you. my surgeon said it is next to impossible to get all the prostate out of the body. your next dr's appt should be interesting to say the least. also, another point for alarm. the failure time frame for the RP is 18 months. you're way early for this type of psa rise time. don't have an answer for that one. have more information if you want it - just let me know. ~ curtis 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 Geez, people, it wasn't long ago that a tenth was the limit of sensitivity; now we are getting bent out of shape over hundreths! Such minute amounts of PSA can be produced by residual benign prostate tissue (usually at the anastamosis) and other glands that produce very small amounts. I'd watch it but not be overly concerned yet. As to that study, look at the followup re metastatic disease - they didn't have any. Against the odds, that pretty much means that all of the men in the study group had local-only recurrences. We all know that RT is very effective in that situation. That's a no-brainer. The difficult decision is whether to undergo RT when there is a high risk (or certainty) of systemic disease. On the other hand, if all of them had local-only recurrences, I was initially surprised that the durable response rate was not better. In other words, RT FAILED to control local recurrences in 9 of the men. This may be explained by 2 factors: 1. the dose was far below what we use in the U.S.; 2. they started too late. I wish they had broken out how the men w/ seminal vesicle involvement did since that is my dilemma. I suspect that they made up most of the failure group. The bottom line is that properly timed and dosed RT is great for local-only recurrences, if that is what you have. It will give an initial PSA response in most all cases because I suspect that most men w/ metastatic disease also have a local recurrences that react to the RT. Given the latter, the question I have is if RT may be warranted in even metastatic cases because, even though not curative, it may offer QOL improvement over the long haul by eliminating urinary issues associated w/ tumor growth at the anastomosis. Of course, that benefit may be offset by any permanent side effects. Just my rambling thoughts. guys. Bill Denton RP 2/12/02 PSA .45 Memphis > Geez, people, it wasn't long ago that a tenth was the limit of > sensitivity; now we are getting bent out of shape over hundreths! Such > minute amounts of PSA can be produced by residual benign prostate > tissue (usually at the anastamosis) and other glands that produce very > small amounts. I'd watch it but not be overly concerned yet. That's exactly what I was saying... until the OP comes back with more info, we won't know. CM he was talking about .01 not .10 ..... do you still think it's worrysome? SignatureJK Sinrod Sinrod Stained Glass Studios www.sinrodstudios.com Coney Island Memories www.sinrodstudios.com/coneymemories My Uro says that their are other blood elements, in very low volumes, that can falsely indicate PSA. That's why he doesn't even look at readings below 0.1. Doesn't help me much with first post op at 0.24, but I'm appredciative of the information regarding salvage radiation cure rates for readings below 2. My fingers are crossed (as are my toes, knees, eyes, ears, testicles, and kidneys)! |
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