Risk categories for radiation therapy

Always look forward to your research reports. As usual, I find it interesting that psa kinetics are not part of the equation.

PSA kinetics have been looked at closely. Unfortunately, the rises and falls are not well correlated with PC progression. The problem is that PSA can rise rapidly from prostatitis and urinary blockage, and it can rise slowly and steadily due to BPH. There are ways to make PSA more specific to PC, like PHI, 4KScore or by using 5ARis - or to skirt the problematic PSA issue entirely using novel biomarkers. Hopefully, we will someday have well-validated replacement biomarkers.

Thanks TA. I like ready those reports. I too came in at 121 intermediate risks. I had the Prolaris test as requested by my MO just to see where my G9 would fall and help us decide how aggressive we should be with treatment (such as adding chemo after RT). I think these types of test should be added to the risks categories somewhere along the process after PC is confirmed and second opinions are requested. -JR

This classification is in line with the consensus of the doctors I saw after diagnosis. My high PSA and 100% of the biopsy cores being positive significantly drove up the score to 240.

Based on the bPFS of 67% at five years I appear to be ahead of the game. Glad I had aggressive initial treatment.

Great article Allen, thanks for your valuable contributions.

Breaking this down further, I think my high PSA and number of positive cores was somewhat driven a lot of G3. Overall, every core had a component of G3. Based on tumor load 3 gives off more PSA than 4 and I think either 3 or 4 cores were G 3+3. Looking at the risk matrix and weighting, I interpret this to mean that a larger amount of less aggressive cancer may present more risk than smaller amounts of more aggressive cancer. It seems counter-intuitive to me that a G9 could be a lower risk, as I have generally associated risk primarily based on the highest G score. I am conditioned this way by my urologist who basically says to treat at the level of the highest G score.

I am glad Michael is doing so well, as many other of our G9s are. I haven't seen a G9 "lite" in any of the classifications, but I do applaud the optimism.

JNF and Michael-T,
Keep in mind that patients in this study received 76 Gy of external beam radiation (most with ADT), which is on the lowish side. You guys had much higher effective doses than that. The researchers found that bPFS increased by over 10% for each additional Gy of radiation in the range they used, so that could make quite a large impact.

As you're pointing out, the weighting of PSA seems different than most thinking. A person with a doubling time less than a year, say going from 3 to 6, is still weighted inconsequential by itself. In comparison a PSA >7 bumps a person up about one tier in the lower levels. You mention other non-PCa drivers of PSA, but does this table assume those drivers are already eliminated?

Also, I guess this Percentage of Positive Cores applies only to a 12-core random biopsy? Today's guided biopsies inherently should have higher percentages when they are swarming the cores taken at suspicious lesions.

Meanwhile, with my score of 144-intermediate, I was happy that Dr King at UCLA estimated that my proposed SBRT treatment should give me a bPFS at 80% for 5, 10, and 15 years. More optimistic than the decline at 10 years in all cases for this system.

Great article, thanks for posting!
Jim