This is the exact thread I am in need of at this moment. I have previously sent in pathology details to Dr. Krongrad with response fairly positive for me. Short story, is 2 postive margins, “focal” (very small) extracapsular involvement, negative on SV and LN, all Gleason 3+3, some nerve invasion (I have still not understood exactly what this is).

Status now is I have just cleared a second staph infection after RP on April 14. Doing quite well. Continence slowly improving, I am probably about 90% though hard to rate. I change brief about once during a work day — desk job. ED completely with minimal response, take Viagra every day.

Issue now is that I have just now been able to get blood drawn for the first post op PSA because of the staph infection. Meeting the doc (Miles in Houston) on June 11 for the first consultation. I did meet him in the hall on last Monday when I went in for the urine culture to see if they had eliminated the staph. Thankfully it is gone. That was a real bump in the road. I told Miles that I had been studying up and looking at all I could and was preparting myself for the IMRT. He put his arm over my shoulder and said compassionately “we won’t worry about that right now” He believes that with my stats I have only a 25% chance of recurrence and his prognosis is that “salvage RT works as well as ART so the wait and see approach is his approach. I am happy to know this as I do not look forward to the potential side effects of the IMRT. Despite some good reports on minimal side effects, the bad reports scare me and I certainly don’t look forward to the regimine of the RT itself.

Anyway, I will follow this thread closely, since it fits my circumstances well. I will post on my PSA when I get it Monday and will let everyone know what the doc says when I go in on Wed June 11.

In the meantime any feedback from all of you is appreciated. Dr Kronongrad has already given me good feedback and his opinion was a good prognosis as well.

Best to all, Ken

As I suspected, the paper published in European Urology and abstract 522 from the AUA are about very different types of data. The European Urology paper deals with patients who had immediate (adjuvant) radiotherapy as a planned follow-up to their surgery, whereas abstract 522 from the AUA deals with true “salvage” radiation therapy for only a subset of patients with a rising PSA some time after surgery. It would be impossible for anyone to tell you the relevance of the AUA abstract data to the situation you are looking at without knowing whether you meet the precise criteria of these data. If you read the abstract above, you will see that all the patients summarized in this retrospective review had had extracapsular extension or positive surgical margins or seminal vesicle invasion and/or positive lymph nodes at the time of surgery.

So. Given the above information, our suggestion would be that you look at the page that talks about the Kattan nomograms at http://prostatecancerinfolink.net/tips-tools/kattan-nomograms/. One of the Kattan nomograms offers a specific method for assessing the potential for success of salvage radiation therapy following a rising PSA after radical prostatectomy. By entering data specific to the individual patient, you would be able to get a reasonably accurate idea of the probability of success for that particular patient.

[522] LONG-TERM BIOCHEMICAL CURE RATES WITH INITIAL OBSERVATION AND DELAYED SALVAGE RADIOTHERAPY AFTER RADICAL PROSTATECTOMY FOR HIGH-RISK PROSTATE CANCER

Stacy Loeb*, Baltimore, MD, Kimberly A Roehl, St Louis, MO, Davis P Viprikasit, William J Catalona, Chicago, IL

INTRODUCTION AND OBJECTIVE: Randomized trials have shown an improvement in progression-free survival rates with adjuvant radiation therapy (ART) after radical prostatectomy for patients with a high-risk of cancer recurrence. Less is known on the relative advantages and disadvantages of initial observation with delayed salvage radiation therapy (SRT).
METHODS: From a radical prostatectomy database, we identified 890 men with positive surgical margins (SM+), extracapsular tumor extension (ECE), seminal vesicle invasion (SVI), and/or lymph node metastases (LN+) who did not receive ART. Following a period of initial observation, 199 ultimately received SRT. We calculated long term biochemical cure rates by adding together the 7-year biochemical progression-free survival rate with observation alone to the proportion of men who maintained an undetectable PSA level for 5 years after salvage therapy.
RESULTS: In patients with SM+/ECE, SVI, and LN+, the 7-year progression free survival rates with observation were 62%, 32%, and 7%, respectively. Among those who failed, 56%, 26%, and 0%, respectively, maintained an undetectable PSA for 5 years after salvage radiotherapy. The long-term biochemical cure rates associated with a SRT strategy were 83%, 50%, and 7% for men with SM+/ECE, SVI, and LN+, respectively. In the subset of 615 men who did not receive hormonal therapy, the corresponding long-term biochemical cure rates were 91%, 75%, and 17%, respectively.
CONCLUSIONS: Following radical prostatectomy, initial observation followed by delayed SRT at the time of PSA recurrence is an effective strategy for patients with SM+/ECE. Selected patients with SVI may also benefit from this strategy, while SRT is unlikely to benefit LN+ patients.

I will have to check on this for you tomorrow. There may be a difference between the paper published by Loeb et al. in European Urology and the abstract presented at the AUA — or they may be the same data. What I can tell you at this point in time is that, depending on the precise nature of the patient’s post-surgical situation, post-surgical salvage radiation therapy (with or without, but often with) adjuvant hormone therapy is a well understood and well-established form of therapy which can have a high long-term response rate in certain patients. Critical factors include the patient’s pathological Gleason score, the PSA velocity or doubling time post surgery, and the patient’s origional PSA, in addition to other factors.

Wednesday, 28 May 2008

ORLANDO, FL (UroToday.com) – Highlights of the advance prostate cancer session included; effectiveness of salvage radiation therapy for a rising PSA after radical prostatectomy…

Abstract 522 evaluated men with a rising PSA after radical prostatectomy. External beam radiation was able to provide long-term biochemical-free survival in 83%, 50%, and 7% of patients with positive surgical margins, seminal vesicle invasion, and positive lymph nodes, respectively.
http://tinyurl.com/6prjsr