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Are castration sensitive prostate cancer patients being over treated?

Posted by jeff Marchi @jeffmarc, Jan 31 8:31pm

Ancan.Org had a meeting with doctors from the National Cancer Institute to discuss over treatment of patients that had BCR (biochemically, recurrent prostate cancer). They discussed a lot of the reasons why patients are being over treated today, when their PSA starts to rise or a PSMA pet test shows faint possibilities..

One interesting thing was, they say that people with CSPC shouldn’t start counting the doubling rate until their PSA hits .5 or even 1.

This meeting was instigated by the following article

https://ascopubs.org/doi/abs/10.1200/JCO-25-01693

Here is the video from Ancan’s meeting with the doctors to discuss over treating patients due to PSMA pet testing and other test results, referred to as PSMA+BCR.

Here is a link to the video conference

https://ancan.us14.list-manage.com/track/click

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

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jeff Marchi | @jeffmarc | Feb 4 12:19pm

Some of the questions in here were questioning whether salvage radiation was needed at a .2 PSA. I emailed Dr. Abel Asking about whether salvage radiation made sense or should people wait. She replied within a half hour. Here are her thoughts on the need for salvage radiation when the PSA hits .2 after a Prostatectomy.

Thanks for listening to our talk. Dr. Madan and I both are in favor of salvage RT and recommend it to eligible patients. I would not usually factor the doubling time into a decision about salvage; it is more a question of how high the chance of cure with salvage is.

The initial studies for salvage RT in BCR patients were before PSMA PET scans, which may help better identify which patients are most likely to benefit from salvage than just the PSA value alone (example - if the PSMA pet detects small lymph nodes with cancer beyond the radiation area, then salvage is not going to be curative).

Our studies and recommendations are for patients who have either had salvage or declined to do it, where the goal of therapy is no longer focused on a potential cure. Most of our patients come to us when PSA begins rising after salvage therapy.

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surftohealth88 | @surftohealth88 | Feb 4 2:48pm
In reply to @jeffmarc "Some of the questions in here were questioning whether salvage radiation was needed at a .2..." + (show)
Profile picture for jeff Marchi @jeffmarc

Some of the questions in here were questioning whether salvage radiation was needed at a .2 PSA. I emailed Dr. Abel Asking about whether salvage radiation made sense or should people wait. She replied within a half hour. Here are her thoughts on the need for salvage radiation when the PSA hits .2 after a Prostatectomy.

Thanks for listening to our talk. Dr. Madan and I both are in favor of salvage RT and recommend it to eligible patients. I would not usually factor the doubling time into a decision about salvage; it is more a question of how high the chance of cure with salvage is.

The initial studies for salvage RT in BCR patients were before PSMA PET scans, which may help better identify which patients are most likely to benefit from salvage than just the PSA value alone (example - if the PSMA pet detects small lymph nodes with cancer beyond the radiation area, then salvage is not going to be curative).

Our studies and recommendations are for patients who have either had salvage or declined to do it, where the goal of therapy is no longer focused on a potential cure. Most of our patients come to us when PSA begins rising after salvage therapy.

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@jeffmarc

Thanks Jeff for doing so !!! < 3
Now it all is much more clear : )))

I know that doctors do not read this but regardless, I would like to thank Dr. Abel for taking time to answer your question and help us all here better understand their reasoning and their study < 3

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fbuckwalter | @fbuckwalter | Feb 4 3:52pm
In reply to @colleenyoung "@fbuckwalter , welcome. You're right that there are a ton of acronyms to learn with cancer..." + (show)
Profile picture for Colleen Young, Connect Director @colleenyoung

@fbuckwalter , welcome. You're right that there are a ton of acronyms to learn with cancer diagnosis. The guys have built a list here:
- Prostate cancer-related abbreviations: What acronym would you add?https://connect.mayoclinic.org/discussion/prostate-cancer-related-abbreviations-what-acronym-would-you-add/

As for using AI to search for information and decision making for health, it's top priority to fact check. AI tools do not replace human judgment or oversight. Any text, image, or video generated by AI should be used only as a starting point, not as verified information. It may contain inaccuracies, biases, and other problems. Generative AI tools can sometimes generate plausible-sounding answers that are wrong.

Here's some sound advice about using AI
- What is Generative AI? What does this mean on Mayo Clinic Connect? https://connect.mayoclinic.org/blog/about-connect/newsfeed-post/what-is-generative-ai-artificial-intelligence-what-does-this-mean-on-mayo-clinic-connect/

fbuckwalter, Is your oncologist suggesting another androgen therapy with the rising PSA? What are next steps?

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@colleenyoung
I thought I replied but may not have. I am scheduled for a PSA in June. I had surgery in PA and have follow up care at Moffit since I moved to FL. Surgery was in 2014. In the mean time went thru a bout with throat cancer and had surgery at Penn.

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rnpalarino1 | @rnpalarino1 | Feb 5 7:24am

Sometimes I think these doctors are a bunch of old time car mechanics trying to figure out what is wrong with your car and how to fix it. But I understand they are doing their best in most cases and many of us should thank God we are still alive and our quality of life is good, even though we ended up with prostate cancer from Agent Orange.

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jime51 | @jime51 | Feb 5 9:12am
In reply to @gkgdawg "@heavyphil Hi, my husband's Gleason score was 7. He had a PSMA and that determined that..." + (show)
Profile picture for gkgdawg @gkgdawg

@heavyphil Hi, my husband's Gleason score was 7. He had a PSMA and that determined that the cancer had metastasized. I don't know what a Decipher test is

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@gkgdawg Yes! Mine was Gleason 7 with metastasis to two nearby lymph nodes. 44 radiation treatments and 18 months ADT, hopefully completed late June.

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gkgdawg | @gkgdawg | Feb 5 1:14pm

The medical oncologist said we will take another look in May (when he will have been on ADT for 1 year. The ADT certainly has its drawbacks

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jeff Marchi | @jeffmarc | Feb 7 10:53am

This article May be of interest to many people. Bring it back to the top.

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