Treatment after recurrence following prostatectomy

Hi guys:

I previously posted about this a few weeks ago, but at the time did not have the data.

If you are seeing recurrence after prostatectomy I think you would benefit from reading the following:

https://www.astro.org/ASTRO/media/ASTRO/News%20and%20Publications/Press%20Kits/PDFs/PollackNewsBriefingslides.pdf

This study started in 2008 and is due to be completed in 2025, but some preliminary data were released a couple of years ago. And more data is expected to be released in December 2020.

The rationale for doing this study was that when people seeing recurrence after prostatectomy get radiation treatment, ~10 years later about 30% have seen their cancer recur a second time. If lengthy 'androgen deprivation therapy' is added to the radiation, the results seem to be improved.

This study wanted to see whether the results might be better if the androgen deprivation (which has significant side effects) period is greatly shortened, and the lymph nodes are irradiated in addition to the prostate area. The underlying assumption is that the reason many of the 30% who experience a second recurrence after radiation is applied to the 'prostate bed' only, may be that their cancer had already spread to the lymph nodes. Possibly irradiating the lymph nodes as well may kill all the cancer in some patients, assuming it hasn't gone further already.

This study has already found that doing all three treatments reduces the percentage seeing recurrence at eight years from about 30% (prostate radiation only) to about 10% (all three).

There is also the issue of the PSA at time of treatment. They are looking at patients whose PSAs were in two groups: A) under 1; and B) between 1 and 2.

These data are more encouraging than those of the previous studies I had seen. Perhaps an appreciable percentage of patients undergoing this treatment may never see recurrence? A year from now I should know the answer in my case. It is very likely my PSA will drop back to near zero after the treatment is finished, and one year from now an ultrasensitive PSA test will likely show if it is coming back again. Obviously, hopefully it will not.

My treatment is: one injection of Lupron. No big deal. Followed by one 50 mg pill daily for 30 days of Bicalutamide. Then, a CT scan to try to figure out where to aim the radiation, followed by 35 days (five days a week for seven weeks) of 15 minute radiation treatments to the prostate bed and local lymph nodes.

The Lupron and the pills are supposed to have immediate side effects, but I cannot say I have noticed any. I have been a little more tired than usual in the late afternoon, but my cat has been waking me up at night too!

One other little detail in these data: notice the numbers at the bottom of the charts for 'number at risk'? They seem to show that eight years after treatment, 90% of the patients are dead already, but the great majority not from prostate cancer!!!!! Which explains why, while autopsy studies have shown that 60% of men in their 70s have cancer cells in their prostates at time of death, only between 3% and 4% of men die from it.

Good luck, folks.

Rodney.

R-0.009 (are you a secret agent , close to 0.007?? ) lol, thats an ultra low PSA man!
Here's your link, I tried to make it made clickable, but it did not display, maybe it will for others:

https://www.astro.org/astro/media/astro/news%20and%20publications/press%20kits

Wingman

From a 2018 release of data.

Favorable Population

In terms of patient characteristics, said Dr. -Pollack, this was a relatively favorable salvage radiotherapy population, with 85% of patients having no seminal vesicle involvement, 54% having organ-confined disease (pT2), and 50% having positive prostatectomy margins. In addition, approximately 68% of these patients had Gleason 7 disease, whereas very few had Gleason 8 or 9 disease. Finally, the median PSA level was low (0.34 ng/mL), and 25% of patients had PSA levels of 0.2 ng/mL or less.

Thanks Duck2:

Good point. It is a favourable population. Their parameters are quite like mine so I find it more interesting than some people might.

Also I think a major purpose of the study was to check if 'spread to the lymph nodes' might be a significant part of the problem with second recurrences. I suspect they thought that including a lot of worse cases would make it more difficult to figure that out.

Incidentally, while I am here I recently found two very interesting papers which may explain why I have prostate cancer. (Yes, I know more than half of men in their 70s have cancer cells in their prostates at time of death, but .....) One paper reported that having had *appendicitis* nearly doubles the chance of having prostate cancer. (I had a ruptured appendix 40 years ago) And another paper reported that the 'hazard ratio' for prostate cancer for those who have had *hip surgery* is a huge 14! I have not had hip surgery but in 1980 I had surgery for a comminuted left femur, in which they drilled a hole in the top of the femur - right next to my hip - inserted a rod down the hole, assembled the bone fragments around the rod and secured it all with copper wire.

So, what could be the connection? My bet is that it is diagnostic x-rays. I must have had 20 to 30 x-rays of my femur in the hospital, and probably some with the appendicitis as well.

If correct the lessons appear to be A) make sure x-ray techs provide patients with lead aprons, B) anyone who has had pelvic x-rays should be warned to check their PSA very carefully on a regular basis.

........ Unless someone can come up with a better explanation for the very substantially increased risks associated with hip surgery and appendicitis?

Rodney.