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Does SRT and ADT after BCR improve length of surival compaired to no treatement.

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Posted 9/5/2018 12:52 AM (GMT 0)
Since I will be visiting MDA in Gilbert AZ in a couple of weeks to see what they offer for BCR I have been thinking about what the expected results from the different treatments might be.

This site has helped greatly in having an understanding of the possible treatments and their possible side effects. Mulling these questions ( spend way to much time researching in the middle of the night ) got me to thinking about what can be expected from the standard treatments.

I narrowed the thoughts down to the basic: Will the standard treatments ( SRT/ADT ) provide a chance for a longer survival in spite of possible side effects or will taking no treatment at all with no side effects have close to the same survival numbers?

I do have an aggressive case, psa 20, gleason 4x4 that came back after 8 years. I think it is perfectly normal for people in this position to feel that "something" must be done to correct the problem.

Being OCD about things like this, I am rounding up my list of questions for the doctor before deciding on what the next steps may be.

Would appreciate your thoughts on this.
Posted 9/5/2018 1:36 AM (GMT 0)
I think, but I’m not sure, that I’ve read that there is no proof that SRT prolongs survival. I can’t remember where I’ve read it.
IMO though, if it doesn’t prolong survival but it does prolong time to permanent ADT, then it’s worth it.

On the other hand, for guys post Ralph , with BCR, or low but unstable,PSA, (like me), it’s a last chance for a cure. But that would negate my first statement. Really just want to keep this near the top.
If it exists, Tall Allen probably has a study to refer you to.
Posted 9/5/2018 1:57 AM (GMT 0)
Thanks for your input Pratoman,

I forgot to include in my OP that the question is aimed at medium to high risk cases. Have enjoyed not having to wear pads due to incontinence for years and would hate to go major step backwards in that area.

Appreciate your thoughts!
Posted 9/5/2018 2:01 PM (GMT 0)
twotall,
I don't know. I don't think there are studies showing it does, but I could be wrong. But in my case, SRT bought me a very long remission of 8 years before needing to go on ADT. I had three months on Casodex during SRT, but otherwise remained treatment free until recently. I had no permanent SEs from the radiation. There was a period of moderate intermittent rectal bleeding that started about ten months after the last treatment. It came and went and moderated until full return to normal over the course of a year. Otherwise no new SEs.
Jim
Posted 9/5/2018 2:37 PM (GMT 0)
BCR after 8 years would most likely mean that its still local. With that assumption - and that you were 4+4 , why not throw the kitchen sink (ADT+SRT) now and not wait and still try for the cure.
Posted 9/5/2018 3:09 PM (GMT 0)
I would agree with ddyss....A CURE in your case is still possible. I would not pass that opportunity up just to avoid some temporary side-effects...Radiation treatment has come a LONG way over the past 5 or 10 years..Anything you have read that's based on older treatment methods is no longer valid..Talk to an RO about radiation treatment, not a MO or Uro....
Posted 9/5/2018 3:58 PM (GMT 0)
Any chance or a treatment in my case to help me postpone the start of ADT?
My MO suggested that I need to start it due to 5.5 PSADT. thanks
Posted 9/5/2018 7:08 PM (GMT 0)
Here's a nomogram that gives the probability that SRT will work. I doubt that many men in their database had your specific high risk characteristics, so take it with a grain of salt. "Survival" is difficult to measure because the natural history of the disease is so long, and it is very expensive to track men in a clinical trial that long. Metastasis-free survival has proven to be a good surrogate endpoint (meaning it correlates well with overall survival), and biochemical recurrence-free survival is pretty good too, and is most often used.

riskcalc.org/ProstateCancerAfterRadicalProstatectomyNew/
Posted 9/5/2018 9:12 PM (GMT 0)

twotall said...
Will the standard treatments ( SRT/ADT ) provide a chance for a longer survival...

Guidelines base their recommendation for SRT on this study:
Prostate cancer-specific survival following salvage radiotherapy vs observation in men with biochemical recurrence after radical prostatectomy.

It says: "Salvage radiotherapy alone was associated with a significant 3-fold increase in prostate cancer-specific survival relative to those who received no salvage treatment...Addition of hormonal therapy to salvage radiotherapy was not associated with any additional increase in prostate cancer-specific survival ... The increase in prostate cancer-specific survival associated with salvage radiotherapy was limited to men with a prostate-specific antigen doubling time of less than 6 months and remained after adjustment for pathological stage and other established prognostic factors."

George
Posted 9/6/2018 3:16 AM (GMT 0)
I really appreciate everyone's input.

Tall Allan and George, thanks for the links.

I have spent way to much time researching this subject over the last 8 years as it was always in the back of my mind that it could come back. Knowledge is good but sometimes can cause an over active mind and worry.

With your help I am getting my question list ready for the Dr. on the 18th. When they called me I requested a doctor that would not mind me asking questions. They said I would have a provider as a main contact. The provider would then consult with other doctors concerning best treatments.

Fairwind, it is encouraging that a cure might still be a possibility. As I told my wife, suddenly we have a whole new adventure ahead of us. She wasn't thrilled.
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