On August 7, WSF wrote:

(snip)

I believe that the clinical markers would be, at least, high Gleason,
stage T2b or c, and low PSA.

Frex, Gleason 4+5=9 and PSA of only 5.7 ng/mL with the above clinical stage.

Chances are, per Strum, this would not only be high-risk but systemic,
which is not necessarily the same as metastatic. Remember that there can
be metastases that are too small to be detectable with present technology.

Regards,

Steve J

That's what I got from it, too.  It's not an answer to the question of what
to do when confronted with recurrence, but rather what to do when the lymph
nodes are positive.  (I didn't see anything one way or the other about
whether they screened for metastates.)

This is the link to the abstract:

http://tinyurl.com/yw3aow

(That was my first attempt at Tiny Urls.  I feel so grown-up ...)

The study RalphV mentions does appear to answer an important question,
though.  

--charlie

Hi Alan,
First, you are correct. In this study recurrence was not identified,
but adjuvant ADT was applied after primary therapy ( RP or RT) in an
effort to improve survival in patients with poor prognosis. The
keyword seems to be early intervention in such cases. Messing urgery
to be beneficial. The problem with this is that many surgeon will not
perform surgery on glands that have been suppressed(it makes for a
more difficult procedure).

All this said, the essence of the study is that men with poor
prognosis after primary therapy should be considered "cured" when
treated with adjuvant ADT. These men tend to live as long as
contemporaries who were never diagnosed with PCa. In Europe
researchers have been associating the current improvement in the PCa
mortality rate with precisely the early use of ADT in early detected
non localized PCa. This is yet to be proven by clinical trial, but
until then is a possible explanation for the current mortality trend.

I interpreted the use of adjuvant ADT in the study in question as
either permanent or intermittent since the later seems as effective in
promoting survival with less SEs than the permanent form. This w/o
reading the full article.

See WA in support of adjuvant ADT with 3X Casodex wrote: "Prostate
cancer is being diagnosed at an earlier age and earlier disease stage
than previously and increasing numbers of relatively young men are
receiving potentially curative radical prostatectomy or radiotherapy
for early prostate cancer. Although many of these men have an
excellent outcome, a significant proportion subsequently experience
disease recurrence or cancer-related death. Men with unfavorable tumor
characteristics at the time of radical prostatectomy or radiotherapy
are particularly at high risk of experiencing disease recurrence. One
strategy to improve outcome for these men is adjuvant hormone therapy
(hormone therapy administered immediately after therapy of primary
curative intent). Surgical castration (bilateral orchiectomy), medical
castration using the luteinizing hormone-releasing hormone (LHRH)
agonist goserelin, and antiandrogen monotherapy have been investigated
as adjuvant hormone therapy to radical prostatectomy and radiotherapy,
and each therapy has demonstrated clinical benefits because of a
significant improvement in disease-free survival. Furthermore, data
are available to indicate that adjuvant hormone therapy achieved by
goserelin or bilateral orchiectomy improves overall survival,
particularly in men at high risk of progression. Because the effects
of LHRH agonists are reversible, they provide a more acceptable method
of adjuvant therapy compared to bilateral orchiectomy, particularly in
the adjuvant setting, and are preferred by patients. However, the
adverse effects on quality of life, in particular on sexual interest
and function and bone mineral density, may limit the use of LHRH
agonists in some patients. However, these parameters are maintained
with nonsteroidal antiandrogens. The first data from the Early
Prostate Cancer program indicate that adjuvant bicalutamide 150 mg is
associated with a significant improvement in progression-free survival
after radical prostatectomy or radiotherapy.
Gynecomastia and breast pain are the most common side effects
associated with bicalutamide therapy. Medical or surgical castration
in combination with an antiandrogen (combined androgen blockade) is
another option for use as an adjuvant hormone therapy. However, no
study has reported on the use of combined androgen blockade in this
setting. Adjuvant hormone therapy provides clinicians with another
treatment option for patients with early prostate cancer and
unfavorable tumor characteristics.

In my view, the use of early adjuvant ADT has not been totally
accepted and kept in the dark because no one has a preference for even
temporary castration and the potential for temporary and permanent
side effects without support studies like RT has. Ultimately it should
be the patient's decision to chose to be treated or not. The notion
for a potential advantage of adjuvant therapy after surgery has not
been as exposed to the public as the case for adjuvant therapy after
RT, but that is not to say that the benefit was not recognized as
early as the late 80s. Such studies exist. Here are some references"

See WA, et al. Bicalutamide as immediate therapy either alone or as
adjuvant to standard care of patients with localized or locally
advanced prostate cancer: first analysis of the early prostate cancer
program.
J Urol ? 2002 Aug;168(2):429-35

Prayer-Galetti T, et al.: Disease free survival in patients with
pathological "C stage" prostate cancer at radical retropubic
prostatectomy submitted to adjuvant hormonal treatment. Eur Urol 2000,
38:504.

Messing EM, et al.: Immediate hormonal therapy compared with
observation after radical prostatectomy and pelvic lymphadenectomy in
men with node-positive prostate cancer. N Engl J Med 1999,
341:1781-1788.

Wirth M, et al.: Randomized multicenter trial on adjuvant flutamide
therapy in locally advanced prostate cancer after radical surgery:
interim analysis of treatment effect and prognostic factors
[abstract]. Br J Urol 1997, 80(Suppl 2):1033a.

Lerner SE, Blute ML, Zincke H. Extended experience with radical
prostatectomy for clinical stage T3 prostate
cancer: outcome and contemporary morbidity. J Urol. 1995 Oct;154(4):
1447-52. PMID: 7658555 [PubMed - indexed for MEDLINE]

Best,

RalphV
www.pcainaz.org/phpbb

et al identified recurrence(lymph node involvement) and applied
adjuvant therapy to RP.

Neoadjuvant ADT has not been proven beneficial with surgery as it has
been with RT. Gleave et al tried to demonstrate that longer periods of
suppression are necessary prior to s