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When to begin Salvage Radiation when BCR occurs?
Prostate Cancer | Last Active: Oct 10 10:34am | Replies (16)Comment receiving replies
@chippydoo
Here is the recommendation from a well renowned oncologist.
Adjuvant radiation
Dr. Efstathiou concluded as follows:b
* Early salvage radiotherapy is favored over adjuvant radiotherapy in most patients
* Consider adjuvant radiotherapy in otherwise fit, motivated, very high-risk patients with ≥2 of the following risk factors:
* pT3b-4
* Gleason score 8-10
* pN+ Lymph node Metz
* Decipher score >0.6
* In high-risk patients, use lower thresholds to initiate ‘ultra-early salvage or adjuvant-plus’ radiotherapy
* If giving adjuvant radiotherapy, it implies high-risk disease. Thus, Dr. Efstathiou would recommend treating the prostate bed and pelvic lymph nodes, in addition to short-term versus long-term ADT, depending on risk factors
* May consider genomic classifiers or artificial intelligence tools to help with informed decision-making
* The goal is to avoid (or delay) radiotherapy in those who we can, without missing a window to cure patients who are guaranteed to recur
Here is a link to the article supplied by @surftohealth88 originally
https://www.urotoday.com/conference-highlights/apccc-2024/151546-apccc-2024-debate-how-to-best-manage-a-fit-patient-with-high-risk-localised-and-locally-advanced-prostate-cancer-how-to-select-patients-for-adjuvant-therapy-after-radical-prostatectomy-and-how-to-treat-them.html
Replies to "@chippydoo Here is the recommendation from a well renowned oncologist. Adjuvant radiation Dr. Efstathiou concluded as..."
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@jeffmarc I'm a bit puzzled by the recommendation to consider adjuvant RT over salvage RT when to quote from the presentation: "An updated report of the RADICALS-RT trial of adjuvant versus early salvage radiotherapy was recently published in the Annals of Oncology. At a median follow-up of 7.8 years, there were no significant differences in freedom from distant metastases (93% versus 90%) and overall survival (HR: 0.98, p=0.92). However, patients receiving adjuvant radiotherapy had worse urinary and fecal incontinence one year after randomization (p=0.001), with fecal incontinence remaining significant after ten years (p=0.017).6"
If adjuvant RT is no better than salvage in freedom from distant mets or in overall survival and is worse as far as urinary and fecal incontinence, why would one want to undergo that?
In my own case, as a high-risk patient (Gleason 8, pT3b, but LN-negative) who would consider myself fit and motivated, no doctor I have consulted has proposed doing anything as long as PSA remains undetectable (<0.02 at the lab I've been using). In fact, I recently contacted a renowned cancer center in NYC asking about a consultation and was told to come back when/if my PSA hits 0.1.
I'm happy with following PSA and dealing with a BCR if or when it happens and otherwise getting on with life.