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Re: Update from Meeting with Radiation Oncologist

Mike,
Everything you heard here sounds exactly in line with what I had heard at a similar point in time in 2007. And I had been following the very same studies carefully at that time, though they had just come out. SWOG 8794 and EORTC 22911.

One little statistical note for you to keep in mind: Further analysis of the SWOG study divided the patients into those of PSA 0.2 and below versus those of a higher PSA post surgery. And showed much better long term outcomes for those in the former group. However, keep in mind that the groupings cover a wide range of patients, and just because you fit in one group or the other does not indicate that your specific outcome probabilities match that of the full group.

Specifically, allowing an undetectable PSA to progress to a 0.1 or 0.2 may be detrimental to your true outcome probabilities even though you remain in the same statistical group within the study sample. But in both groups the better long term results came to those getting timely adjuvant radiation.

Furthermore, I don't think the percentages given for "risks" of side effects from the radiation are to be taken very literally. Those side effect statistics will surely be based on followup questionaires which ask patients about the severity of the side effects they encountered. And different patients will subjectively assign different weights, for many reasons.

You're sure on the right track, and I wish you well.

LATEST ULTR-SENSITIVE PSA RESULTS

In mid-December I had my first PSA test following my surgery of Oct 29. The ultra-sensitive test result was 0.015 which the surgeon termed undetectable. I will now meet with my RO in mid-January for an updated discussion.

I am trying to maintain a balanced perspective on the result. The RO said he would not be surprised if my first PSA Test was detectable. So, I regard it as good news, but would regard it as yet another path of continual observation. I would imagine this may mean that I can avoid ADT for now and possibly delay Radiation Treatment for a bit. I will see what the RO says.

I welcome any opinions or suggestions on latest relevant writings to read. I did a search on "undetectable" and am reading through the the resulting posts that it produced.

Radiation Treatments Started

I have now started my radiation treatments. I completed #6 of 38 today. So far, so good.
Prior to treatment, I had a second ultra-sensitive PSA test 3 months after surgery and it was undetectable.(as was the first) For this reason my RO did not feel that ADT was necessary. He said the 5 physicians in his group had different views on when to utilize ADT. I am ok to start radiation but I prefer to not start ADT unless I can be shown a strong reason to do so. So just radiation for now.
I had my mapping completed and lower extremity cast made to hold me in place. It is a smooth process - about 30 minute drive to get there, a few minutes to change, and about 10 minute treatment, and I am on my way home again. I meet weekly with the nurse and doctor to check on side effects. I have consistently followed their advice to have my bladder comfortably full prior to treatment. They also want me to continue to exercise and eat well. In fact, my treatment includes the services of a nutritionist if I need it. It seems like they use diet changes address some of the possible side effects and it seems similar to using diet to Overactive Bladder Syndrome (avoid citrus, tea, and other foods which can irritate the bladder.)

Re: Radiation Treatments Started

I went through salvage radiation 6 months ago. For me it was smooth sailing through out the process. I was very active although I did take a short nap almost every afternoon. I drove one hour each way so my fatigue my be to my early morning drive. I hope your radiation treatment works out as well as mine did. One difference with me is I had 6 months of ADT. I am still dealing with some of those side effects. I go next week for a PSA and I hope it is undetectable. I do not want to be on ADT for an extended period of time. Why did you get salvage radiation if your PSA was undetectable?

Re: Radiation Treatments Started

Both my surgeon and RO were very surprised and concerned that what was thought to be low grade/low involvement, contained cancer turned out to be a higher grade, 50% involved, with multiple positive margins and ECE/bladder neck. The non-focal aspect was also a concern. I am only 57 and with how many cancer had changed rather quickly , my RO felt the risk of recurrence was at the higher end of range of what the tables indicated (at values noted in the first part of the thread). We discussed the option of waiting until the PSA is detectable versus doing the RT while the cells are likely still in the prostate bed. As I read through what happened to most patients in similar circumstances, it seemed many went to RT/ADT combo following PSA rise at about the 2 year mark. So I opted for the more aggressive "do it now" decision. I think BillG stated it well in his reply when he termed it timely adjuvant rather than salvage.

Some related posting info from the www.HealingWell.com which Terry so kindly referred me to:
Several studies recently have found a big advantage to adjuvant radiation (now) over salvage radiation (waiting for PSA to rise). Several studies have showed significant improvement in PSA progression-free survival with adjuvant radiation:
http://meetinglibrary.asco.org/content/107383-134
http://www.ncbi.nlm.nih.gov/pubmed/23084481
http://jurology.com/article/S0022-5347(08)03059-0/abstract

It also seems to be important to get enough radiation: 70 Gy seems to work significantly better than 60 Gy:
http://www.ncbi.nlm.nih.gov/pubmed/22795730

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