Here is the study information for positive seminal vesicle patients (Me) broken down into these four groups:
Group A: RP only. No adjuvant therapies
Group B: RP with adjuvant RT only
Group C: RP with adjuvant HT only
Group D: RP with both adjuvant RT and HT (Again me)
There are two time elapses. 5 year results and 7 year results.
Here's the study:
prostatecancerinfolink.net/2011/09/15/adjuvant-radiation-adt-after-surgery-for-sv-prostate-cancerThe findings of this study show that SVI+ patients have nearly a 300% improvement in biochemical failure rate periods when adding adjuvant HT and adjuvant RT.Here is what I have posted in response to today's article:
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I would be in group D. … I have two thoughts here:
I certainly had confidence when I moved forward with adjuvant therapies that doing something was better than doing nothing after my RP discovered positive seminal vesicles. I certainly did not have this data but I used logic and logic said kicking the cancer while it was down made sense. This study clearly supports that.
However, it is very clear in this study that as time moves on adverse conditions increase. I will be at 5 years post-surgery in February 2012. I am still in the 82% of having not had a relapse by year 5. But year 7 shows a 110% increase in biochemical failure. And we don’t know with this study if after that point biochemical failure rates level off or continue to double. Ugh! This part of this study bugs me.
Here are some more unknowns (some of which may be available in the full paper as opposed to just the abstract):
(1) There is no breakdown of the number of lymph nodes taken at surgery or treated with radiation.
(2) There is no breakdown of how long adjuvant HT was instituted.
(3) There is no Gleason score breakdown, but I would be willing to bet that the vast majority of patients in this cohort were Gleason 7 and above.
I am hopeful by having a surgeon that removed 10 nodes, and a radiation oncologist that irradiated iliac and inguinal nodes during adjuvant therapy, and by having an “on the ball” prostate cancer oncologist that we can do better than the numbers expressed in this study.
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I think one thing is very clear, adjuvant therapies for positive seminal vesicles offers the best disease management. Also knowing that you have positive SVI is extremely important. If a patient has G7 or above with a high PSA (20+) they should try to get this information. For a patient that is electing to have surgery, they will almost always get these results. But if a patient is electing to have other therapies, they should ask if they can get these results through additional testing. That or assume that the SVI is present and have adjuvant combination therapies regardless.
This evidence in this study is compelling and matches other data I have seen. It is my own opinion that doc's not explaining the adjuvant therapy versus salvage therapy options and findings to their SVI+ patients are clearly missing an opportunity to help their patients manage PCa better.
Ugh! SVI+ Tony