Hopkin's RO take on Pos. Margin

At least in my case.....He's looking at the studies showing better outcomes with SRT sooner rather than later.

ADT....4 mos. worth. (He said "We can go without it....but early results are promising.....")


70 percent chance of cure
50 percent chance of impotence
5 to 10 percent chance of more stricture trouble
ADT complicating my existing DVT...he said "We don't normally withhold it for that reason".


questions I needed to ask and didn't....

1) odds of no recurrence if we do nothing (that'll be a low number)
2) odds of incontinence.


I'm thinking about doing it....but....There's other problems. My kidneys are under protocol....and will be MRI'd again Wed. morning. It'll take a few days for the kidney docs to decide whether to take it out or keep monitoring. If they say keep monitoring....I'm gonna tell the RO to juice me up and zap me.

I just have this nagging feeling.....and I can't shake it.


Same tx as G 9 folk (for the most part).....all for basically a G6 patient (5% was 4s).

Something's wrong.........I don't like it. Yet....

IT-

You are doing this in the hope it will be a curative therapy - one and done. So either the adjuvant ADT kills all remaining hormone sensitive PC cells, or it doesn't. If, god forbid, it doesn't, and you go on salvage ADT, you are starting with whatever castration-resistant cells, if any, that are left plus the hormone-sensitive ones that weren't killed. There is no set time for hormone sensitivity - those cells evolve at their own pace whether you use ADT or not, depending on their genotype.

While adjuvant ADT improves SRT outcomes overall, I've never seen a study affirming a benefit in low volume GS 3+4.

ChrisR said...
This was at Hopkins? Sounds odd to me.

Do you know what the Gleason score was at your margin? I’ve read studies from Walsh that says this is important. If it was G6 you may be able to avoid HT and SRT will probably cure you.

I would find out what it was.

G6 at margin.

I think the man just likes ADT! (He even offered it to me when I consulted with him about initial treatment).

To TA's point...."While adjuvant ADT improves SRT outcomes overall, I've never seen a study affirming a benefit in low volume GS 3+4."

He did qualify his statement about using it in cases like mine. He did say that the studies he's referring to about using ADT were with cases worse than mine. (But that didn't let that stop him LOL)


This nomogram does show a 12 to 15% better outcome with the use of ADT/SRT with my numbers. How it gets that I do not know.....


/apervita.com/community/calculator/predictive-nomogram-salvage-radiotherapy-after-radical-prostatectomy

I couldn't open that link, but a problem with nomograms is that they lose predictive value for small subgroups, such as those who were given HT when they only had G6 at the margin.

Here are a couple of references that were for adjuvant ADT used with primary therapy (not salvage therapy), but if ADT is useless in one, it's probably useless in the other:

"our study suggests a benefit in patients with Percent Positive Cores greater than 50%, GS 4+3, or multiple risk factors. "

www.redjournal.org/article/S0360-3016(11)03443-2/fulltext

"Favorable intermediate-risk patients had no significant benefit from the addition of ADT to RT"

www.redjournal.org/article/S0360-3016(12)00856-5/fulltext

Also, since the positive margin was only GS 6 and there may be a small amount of GS 6 left in there, is this something that you want to treat, or is an active surveillance approach better for you? Here's some useful info about the risk of GS 6 sometimes it progresses, but in over half the cases, it never does.

/pcnrv.blogspot.com/2017/11/myth-gleason-6-never-progresses.html

ChrisR said...
Island time. What Tall Allen says is correct. That is why I asked your Gleason score at the Margin. I am surprised the RO at Johns Hopkins is pushing you like this. He must want a new car. I believe Walsh addressed G6 positive margins in his book. I would read it.

Given your G6 at margin all the studies I’ve seen SRT only took care of it.

Find another RO.

I have. It's the RO that Walsh recommends


welcome to medicine

what i wouldn't give to be able to worry about nothing except PSA.

Surgical margin
Stricture
DVT
what are the odds? Anyone a statistician? We know the odds of each one is small. What are the odds of all three?


This is going to self-cath or SPC. I know it. I already know that. **** my PSA LOL who gives a ****???

Think I"ll have another cystoscopy in an a few minutes. Nothin' else to do...