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New Study on adjuvant radiation compared to deferred radiation

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Posted 10/22/2012 2:09 AM (GMT 0)
http://prostatecancerinfolink.net/2012/10/19/immediate-vs-salvage-radiation-therapy-after-surgery-in-men-at-risk-for-progression/

Seems that adjuvant radiation does improve biochemical reoccurrance in the 10 year follow up period.

Posted 10/22/2012 3:11 AM (GMT 0)
this doesn't affect people with negative margins though, right?
Posted 10/22/2012 5:38 AM (GMT 0)
The important take home points I have here are summarized:

1> ART (Adjuvant Radiation Therapy) did improve the time frames to biochemical occurrence over waiting for relapse then going to SRT (Salvage Radiation Therapy) in high risk positive margins cases.

2> There was no survival benefit of ART v. SRT over an extended period of time.

Neither case used adjuvant hormonal therapies. It is not specified if anyone in the SRT class used HT prior to therapy. I am not too terribly happy with this study but it has been long contended it does not necessarily matter if you pre-empt recurrance with adjuvant therapy using radiation. However, that stated, there is information in this study that quality of life may be affected in various ways. First if complication arise from ART then that is a negative. But in cases where complications were nil, then QoL may have been improved by avoiding early hormonal therapies.

Seems like a catch 22. Still I have no regrets about my extensive use of adjuvant therapies and we are awaiting long term results of the studies that show prostate cancer specific mortality rates in ART+AHT versus salvage approaches to both...

Tony
Posted 10/22/2012 8:36 AM (GMT 0)
Not sure I ever understand all the stats listed in these types of studies, but I note a couple of things.
Average follow up was 10.6 years but some had only been followed for 2 months and some for 16 years. I'd rather see stats from a study where all the subjects had been followed up for the same length of time.

All patients had high-risk PCa

The dose used in study was 60Gy. I had 66Gy. I've not heard of anyone having as little as 60Gy for ART or SRT.

Patients in trial were "aged up to 75", but it gives no details of actual, or average ages. I think I'd be interested to see stats for the sub-group aged similar to me.

On another website reporting this it also says that there were more adverse side effects for those irradaited than for those who did "wait and see".

And did I read correctly that it also say that ART/SRT has no affect on overall survival at ten years?
Posted 10/22/2012 12:56 PM (GMT 0)
So still...seems to me the jist of this article is adjuvant radiation helps decrease the possibility of reoccurrence...but has no effect on long term survival rate vs waiting to see what happens and then go for salvage radiation...am I correct? I think this is worse than deciding which initial porcedure to take care of the PC at diagnosis....if you do it, you could have adverse side effects and yet NEVER know if you would have needed it or not..if you don't do it...your stuck wondering if you should have if you do indeed have a BCR....damed if you do or don't...this part s*cks..
Posted 10/22/2012 4:32 PM (GMT 0)
Don't forget that the average patient was 75, so the overall survival would even out just because of the advanced age. This is probably true of most treatments given to elderly patients including primary treatments.
There was a significant difference in biochemical reoccurrance and this should be noted by younger patients that have a greater than 20 years life expectancy.
Posted 10/22/2012 5:53 PM (GMT 0)
As Alf states...the maximum age of accrual in this trial was 75. The average age had to be considerably less. Strangely, the abstract does not state the median age...

I would think that would be important information...

Tony
Posted 10/22/2012 6:17 PM (GMT 0)
Sounds like a scheme to get men to rush into post-surgery radiation, whether they really need it or not.
Doesn't look like the ultimate survival time has any advantage from doing it adjuvant as opposed to salvage, so why spend the money (radiation is a very expensive secondary treatment) and risk the potential of both short term and long term radiation damage if there is no evidence of BCR?

david
Posted 10/22/2012 6:33 PM (GMT 0)
David,
You missed the point. While there was no survival benefit at 10 years there was in younger men a benefit in QoL that delayed the need for HT. Not so much for the older men in fact it was the opposite.

But still the question answered here does not apply to men who chose both adjuvant therapies.

Tony
Posted 10/22/2012 9:35 PM (GMT 0)

John T said...
Don't forget that the average patient was 75, so the overall survival would even out just because of the advanced age. This is probably true of most treatments given to elderly patients including primary treatments.
There was a significant difference in biochemical reoccurrance and this should be noted by younger patients that have a greater than 20 years life expectancy.  But not those with negative margins, John, right?

Posted 10/22/2012 9:47 PM (GMT 0)
DavidG:

To be clear:

"Eligible patients had to have pT2N0M0 or pT3N0M0 disease post-surgery and at least one of the following additional risk factors: extracapsular extension, positive surgical margins, or seminal vesicle invasion."

It is possible to have negative margins and still high risk extra-capsular extension and even worse positive seminal invasion. Positive margins only means that cancer extended to the surgical margins of the dissection.

Tony
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