Where can I find statistics on radiation therapy outcomes after surgery?

KathyLQ

My boyfriend, 71, had prostate surgery (removal) in Nov. The docs now want to give him radiation daily for 7 weeks. They wouldn’t give him statistics, I'm not sure it was discussed.
This isn’t new, thousands of men surely have gone through this. Can anyone please point me to statistics on outcomes of radiation vs. any other form of treatment, after surgery?

djbuk

more information would be usefull
Hi Kathy, I'm no expert and with with no pathology details or psa info post op. there is not much I can say to help. However, it does appear that your boyfriend has a rising psa following his operation and the doctors are thinking that radiation might deal with this and so will likely be treating him with intent of cure. At this stage any remaining cancer cells are likely (hopefully) to be in the prostate bed and so can be targeted with radiation.
This is called salvage radiation and I beleive the outcomes are good. But, a lot depends on factors like psa doubling time, gleason score, extra prostatic extension, surgical margin status and post op. staging.
Other forms of treatment for post surgery are not aimed at cure but at disease management and although some are very effective at slowing down disease they should not be compared with radiation aimed at cure.
There really is too little information and too many variables for you to gain much if anything from what I have said but don't worry - the big guns will be along soon and offer some proper help.

God bless

KathyLQ

djbuk said:

more information would be usefull
Hi Kathy, I'm no expert and with with no pathology details or psa info post op. there is not much I can say to help. However, it does appear that your boyfriend has a rising psa following his operation and the doctors are thinking that radiation might deal with this and so will likely be treating him with intent of cure. At this stage any remaining cancer cells are likely (hopefully) to be in the prostate bed and so can be targeted with radiation.
This is called salvage radiation and I beleive the outcomes are good. But, a lot depends on factors like psa doubling time, gleason score, extra prostatic extension, surgical margin status and post op. staging.
Other forms of treatment for post surgery are not aimed at cure but at disease management and although some are very effective at slowing down disease they should not be compared with radiation aimed at cure.
There really is too little information and too many variables for you to gain much if anything from what I have said but don't worry - the big guns will be along soon and offer some proper help.

God bless

Are there not statistics at some National agency?
I too have had breast cancer. I've had 4 oncologists use a National database which prints off percentages of known outcomes for women with exactly my stage, and my type of cancer, as it pertains to electing to do chemotherapy, radiation, aromatase inhibitors, a combination, or nothing at all.

Surely there is something like that for prostate cancer?

KathyLQ

KathyLQ said:

Are there not statistics at some National agency?
I too have had breast cancer. I've had 4 oncologists use a National database which prints off percentages of known outcomes for women with exactly my stage, and my type of cancer, as it pertains to electing to do chemotherapy, radiation, aromatase inhibitors, a combination, or nothing at all.

Surely there is something like that for prostate cancer?

I found a website with Prediction Tools
There is a thread “Rising PSA after RP” and on it, I found a link to Prediction Tools… on the Memorial Sloan-Kettering Cancer Center website.

This is the kind of thing I was looking for. I hope it might help others too.


http://www.mskcc.org/cancer-care/adult/prostate/prediction-tools

djbuk

KathyLQ said:

I found a website with Prediction Tools
There is a thread “Rising PSA after RP” and on it, I found a link to Prediction Tools… on the Memorial Sloan-Kettering Cancer Center website.

This is the kind of thing I was looking for. I hope it might help others too.


http://www.mskcc.org/cancer-care/adult/prostate/prediction-tools

This may help
http://prostatecancerinfolink.net/tips-tools/kattan-nomograms/

KathyLQ

djbuk said:

This may help
http://prostatecancerinfolink.net/tips-tools/kattan-nomograms/

Same site
It's the same site. kattan-nomograms go back to the Memorial Sloan-Kettering Cancer Center.

mrspjd

KathyLQ said:

Same site
It's the same site. kattan-nomograms go back to the Memorial Sloan-Kettering Cancer Center.

Statistics, questions to ask, & other factors to consider
Hi Kathy,

Since your BF’s RP was over 6 months ago, RT would now be considered “Salvage” (SRT) vs “Adjuvant” (ART). Depending on his PCa staging, other factors may also influence statistical outcome of SRT.

If SRT is being recommended for rising PSA post RP, I suggest researching & then discussing the following topics with your PCa oncologist and RO prior to RT: Do I need RT to the Prostate bed only or to the bed AND local lymph nodes (if not dissected at RP); What total GY dosing will be used and has it been shown to be effective in cases such as mine; Do I need add’l diagnostic testing prior to RT to determine if spread is localized (extent of spread) and if so, which tests are recommended; For rising PSA post RP, is a short course of adjuvant HT (before, during & after RT) advised in my case.

You may also wish to continue your statistical research with add’l key word searches here: http://www.ncbi.nlm.nih.gov/pubmed/21751904
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2692144/

Congrats on being a Survivor yourself and good luck to you both.

mrs pjd
wife of T3 PCa Survivor

caseyh

Try to find the disease
Kathy,

Salvage radiation is often done based on the probability that something was left behind during surgery. I have always found it amusing that doctors who practice evidenced based medicine are willing to zap someone with 39 treatments of radiation based on a guesstimate. I had salvage radiation along with two other patients at MSK over ten years ago and all three of us failed. Radiating the prostate bed does not treat the chains of lymph above the bed that are often the problem. I'm a little wiser today and would not do the treatment without evidence of where the disease is located. I would not be as concerned with salvage radiation statistics as I would be in determining where the disease is. If you know that, radiation can be an effect a cure.

It seem to me that you are dealing with an a fairly aggressive disease that will most likely be managed over a long period of time. My biggest regret about having a failed salvage radiation is that I was exposed to radiation needlessly, and that over the long term, my radiation options are somewhat limited. I think that the consequences to long term management of the disease should be considered when contemplating a particular treatment. There are a limited number of arrows in the quiver.

I would suggest two tests before starting salvage radiation. Color Flow Doppler Ultrasound can be used to examine the scar tissue in the prostate bed to determine if CaP activity is present. Imaging techniques using a Feraheme contrasting agent will highlight positive lymph nodes anyplace in the body. You are likely to experience difficulty finding either of these tests. If you do, contact me via CSN Email and I will try to help.

Good Luck!

Beau2

caseyh said:

Try to find the disease
Kathy,

Salvage radiation is often done based on the probability that something was left behind during surgery. I have always found it amusing that doctors who practice evidenced based medicine are willing to zap someone with 39 treatments of radiation based on a guesstimate. I had salvage radiation along with two other patients at MSK over ten years ago and all three of us failed. Radiating the prostate bed does not treat the chains of lymph above the bed that are often the problem. I'm a little wiser today and would not do the treatment without evidence of where the disease is located. I would not be as concerned with salvage radiation statistics as I would be in determining where the disease is. If you know that, radiation can be an effect a cure.

It seem to me that you are dealing with an a fairly aggressive disease that will most likely be managed over a long period of time. My biggest regret about having a failed salvage radiation is that I was exposed to radiation needlessly, and that over the long term, my radiation options are somewhat limited. I think that the consequences to long term management of the disease should be considered when contemplating a particular treatment. There are a limited number of arrows in the quiver.

I would suggest two tests before starting salvage radiation. Color Flow Doppler Ultrasound can be used to examine the scar tissue in the prostate bed to determine if CaP activity is present. Imaging techniques using a Feraheme contrasting agent will highlight positive lymph nodes anyplace in the body. You are likely to experience difficulty finding either of these tests. If you do, contact me via CSN Email and I will try to help.

Good Luck!

Great reply
Casey,

Great reply ... Especially coming from someone who has experienced the treatment.

It's amazing how much we learn after the fact ... Very glad you passed your knowledge on.

ob66

mrspjd said:

Statistics, questions to ask, & other factors to consider
Hi Kathy,

Since your BF’s RP was over 6 months ago, RT would now be considered “Salvage” (SRT) vs “Adjuvant” (ART). Depending on his PCa staging, other factors may also influence statistical outcome of SRT.

If SRT is being recommended for rising PSA post RP, I suggest researching & then discussing the following topics with your PCa oncologist and RO prior to RT: Do I need RT to the Prostate bed only or to the bed AND local lymph nodes (if not dissected at RP); What total GY dosing will be used and has it been shown to be effective in cases such as mine; Do I need add’l diagnostic testing prior to RT to determine if spread is localized (extent of spread) and if so, which tests are recommended; For rising PSA post RP, is a short course of adjuvant HT (before, during & after RT) advised in my case.

You may also wish to continue your statistical research with add’l key word searches here: http://www.ncbi.nlm.nih.gov/pubmed/21751904
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2692144/

Congrats on being a Survivor yourself and good luck to you both.

mrs pjd
wife of T3 PCa Survivor

Hello mrspjd
It has been a while, and I enjoy your input along with old friends Kongo and Vasco. I have had daVinci in June 2009, AUS in June 2010, RT in July/August 2010 and hormone therapy since May 2010.

All this is because my Ultrasensitive PSA came back 10 months post op with a rise from 0.05 to 0.07---one could call a statistical variation, but nonetheless a slight rise. My doctor, with my support, recommended the above therapy, which I have gone through very successfully. I am at the end of two years of my hormonal therapy (lupron) with the last hormone four month shot in January 2012. All my PSA readings have been Ultrasensitive and have been 0.00.

Like your husband, I was a Stage 3, Gleason 8 going in, so my physicians have been very supportive in using every trick in the book. The only, and I mean only, downside was the two years of hot flashes----I visited my feminine side. I kid that Lupron vs. the potential for death---I will take lupron any day.

My point is you used the term "salvage" after a time period. I am not so sure my efforts are considered salvage at all, but just safe. I really don't think they know if I was an actual rise or not, but with any rise I was good with the treatment regimen. Technically a rise, but actually, who knows. Now I go off my lupron vacation (in the sense I did not have to worry about rise in PSA).

And Kongo, I am still on the dietary recommendations of Dr. David Servan-Schreiber, very similar to UCSF recommendations. Works for me. Diet and exercise until I get any hint they aren't doing the job.

mrspjd

ob66 said:

Hello mrspjd
It has been a while, and I enjoy your input along with old friends Kongo and Vasco. I have had daVinci in June 2009, AUS in June 2010, RT in July/August 2010 and hormone therapy since May 2010.

All this is because my Ultrasensitive PSA came back 10 months post op with a rise from 0.05 to 0.07---one could call a statistical variation, but nonetheless a slight rise. My doctor, with my support, recommended the above therapy, which I have gone through very successfully. I am at the end of two years of my hormonal therapy (lupron) with the last hormone four month shot in January 2012. All my PSA readings have been Ultrasensitive and have been 0.00.

Like your husband, I was a Stage 3, Gleason 8 going in, so my physicians have been very supportive in using every trick in the book. The only, and I mean only, downside was the two years of hot flashes----I visited my feminine side. I kid that Lupron vs. the potential for death---I will take lupron any day.

My point is you used the term "salvage" after a time period. I am not so sure my efforts are considered salvage at all, but just safe. I really don't think they know if I was an actual rise or not, but with any rise I was good with the treatment regimen. Technically a rise, but actually, who knows. Now I go off my lupron vacation (in the sense I did not have to worry about rise in PSA).

And Kongo, I am still on the dietary recommendations of Dr. David Servan-Schreiber, very similar to UCSF recommendations. Works for me. Diet and exercise until I get any hint they aren't doing the job.

Impressive...Congrats on your ultrasensitive 0’s!
Hi Bob,

Your update is great news and I’m very happy for you. It’s good to see you post again. You’ve shared so much info about your PCa journey along the way that I have no doubt your insight & supportive posts have helped, and will continue to help, many readers on this forum, men and women, with and without PCa, as it did for us. We're all in this fight together in one way or another. Thank you for understanding that big little detail.

From what I’ve read, I believe the word “Salvage” is generally the term used when RT for rising PSA is taken 6+ months post RP. But don’t get caught up on a word…perhaps a better word might be “Prudent” or “Proactive” RT (although I'm sure others might disagree). Given your PCa staging and tolerance for ADT (like PJD), I believe your primary and secondary treatment plans were a solid choice and you’ve got the zer0’s to prove it!

Re “I kid that Lupron vs. the potential for death---I will take Lupron any day.” Well said and PJD agrees completely! While he was on ADT3 for 9 months with HDRB and IMRT as primary aggressive txs, his hot flashes were minimal but we had fun with a standing joke about hot flashes (his and mine): "I’m still hot, only now it comes in flashes!"

Best wishes and warm regards to you and Judy. Be well.

M


PS Please tell Judy that her Vegan butternut squash chili recipe is still one of our all time favorite dishes!

XYZ

Beau2 said:

Great reply
Casey,

Great reply ... Especially coming from someone who has experienced the treatment.

It's amazing how much we learn after the fact ... Very glad you passed your knowledge on.

Options for recurrent prostate cancer adenocarcinoma, gleason 8
Hello,
Very well said...It is imperative to learn before the fact. It is precisely for that reason that one should pause and read these forums before making a decision to go ahead with the 'urgency' of treatment proposed. Has anyone investigated or has had Proton treatment for aggressive recurrent cancer of the prostate? The cancer diagnosis given to me at this point is a 50% 50% chance of survival. The 'best' option given to me is: radiation therapy plus hormone treatment to treat the prostate bed. The cancer tumor is microscopic...therefore it cannot be felt or seen. However, the urologist was willing to give a telephone description of the site of the cysto. exam that produced a diagnosis of adenocarcinoma, with an 8 gleason score.
Contacted the MDAnderson in Jacksonville which has the Proton equipment; but, got a letter in the mail stating 'they' were not using Proton treatment for salvage prostatectomy procedures 'anymore'. Does anyone know why?
Also contacted MDAnderson in Houston via phone and sent all of the information including slides and previous reports...they did not give me a telephone conference...has to be in person for the discussion of possible treatment with them.
Also contacted: MDAnderson in Orlando, Florida they are expecting to have within the next two years the use of the Proton equipment in that location. For now, they do not have it so they offer radiation and hormone treatment.
In addition, for those of us still under the insurance program provided by the employer which does not cover out of range treatment...Texas seems unavailable. Also, the option to change to Medicare primary is only offered within a window of time each year...and the primary insurance provided via work benefits will not pick up the cost...So, even when perhaps a better option to treat the illness is available it is not reachable.
So, my question is: Is there an option to wait until the 'switch' date of insurance to Medicare in order to benefit from the Proton treatment perhaps available in Houston?
And is it true that it is not prudent to postpone treatment for the microscopic cancer cells could be 'anywhere' and will multiply in size and number unless killed with radiation treatment and hormone follow up NOW!?
Plus is it o.k. for the insurance in the workplace NOT TO COVER OUT OF RANGE PROCEDURE THAT IS BEST FOR THE PATIENT? because there is something else less promising that can 'treat' the cancer and cause side effects that are irreversable!?

ob66

mrspjd said:

Impressive...Congrats on your ultrasensitive 0’s!
Hi Bob,

Your update is great news and I’m very happy for you. It’s good to see you post again. You’ve shared so much info about your PCa journey along the way that I have no doubt your insight & supportive posts have helped, and will continue to help, many readers on this forum, men and women, with and without PCa, as it did for us. We're all in this fight together in one way or another. Thank you for understanding that big little detail.

From what I’ve read, I believe the word “Salvage” is generally the term used when RT for rising PSA is taken 6+ months post RP. But don’t get caught up on a word…perhaps a better word might be “Prudent” or “Proactive” RT (although I'm sure others might disagree). Given your PCa staging and tolerance for ADT (like PJD), I believe your primary and secondary treatment plans were a solid choice and you’ve got the zer0’s to prove it!

Re “I kid that Lupron vs. the potential for death---I will take Lupron any day.” Well said and PJD agrees completely! While he was on ADT3 for 9 months with HDRB and IMRT as primary aggressive txs, his hot flashes were minimal but we had fun with a standing joke about hot flashes (his and mine): "I’m still hot, only now it comes in flashes!"

Best wishes and warm regards to you and Judy. Be well.

M


PS Please tell Judy that her Vegan butternut squash chili recipe is still one of our all time favorite dishes!

From Judy to you mrspjd
Another favorite of ours:

Quinoa-Stuffed Squash

Hands on time 37 minutes
Total time 1 hr. 47 minutes

4 (1pound) golden nugget squashes
Cooking spray
2 (4 ounce) links hot turkey Italian sausage, casings removed
1/2 cup finely chopped carrot
1/2 cup finely chopped onion
2 garlic cloves, minced
1/2 cup water
2 cups quinoa
2 tablespoons chopped fresh parsley
1/2 teaspoon chopped fresh thyme
1/4 teaspoon kosher salt
1/4 teaspoon black pepper
3/4 cup (3 ounces) shredded Monterrey Jack cheese (use Daiya for dairy free), divided


1. Cut the top off each squash. Discard seeds. Arrrange squash, cut sides down in 2 (11X7 inch) baking dishes. Fill each dish with 1 inch of water; microwave 1 dish at HIGH 15 minutes. Remove dish.

2. Preheat oven to 350

3. Heat a large skillet over medium high heat. Coat pan with cooking spray. Add sausage' sauté' 5 minutes or until browned, stirring to crumble. Remove sausage with a slotted spoon. Add carrot, onion, and garlic to drippings in pan; sauté' 2 minutes, stirring frequently. Stir in 1/2 cup water' bring to a boil. Reduce heat to medium; cover and cook 8 minutes or until carrot is tender.

4. Combine sausage, carrot mixture, quinoa, parsley, thyme, salt, and pepper; stir in 1/2 cup cheese (Daiya). Stuff about 1 cup quinoa mixture in each squash, and top each serving with 1 tablespoon non dairy cheese. Arrange stuffed squashes in a broiler safe baking dish, and place tops in dish. Bake at 350 for 30 minutes or more, or until thoroughly heated (recipe says 20 minutes, Judy has found 30 minutes is more reasonable, but check at 20). Remove from oven.

5. Preheat broiler to high.

6. Broil squashes 4 minutes or until cheese is golden.

SERVES: 4 (serving size; 1 stuffed squash
CALORIES: 362 FAT: 14.6 gm. PROTEIN: 21.5 gm. CARBS: 39.4 gm. FIBER: 4.7 GM CHOL: 53 mg. SODIUM: 620 mg.

Enjoy. I will type out a Mango Gazpacho soup later. Off to golf now.