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Chances of success for SRT?

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Posted 4/7/2012 3:44 PM (GMT 0)
Hi,

I'm wondering about the chances of success with SRT followed an unsuccessful robotic surgery....

My Dad (61) has robotic surgery last august for a G7 (4+3) cancer with a pre-surgery PSA of 19. The surgeon said it was one of the biggest prostates he had ever removed, and that he had left some of it behind during surgery

After the surgery he never received a non-detectable PSA; it was 0.2, 0.2, 0.2 and finally 0.3 this March
He has just started SRT, and will be receiving 35 treatments in total

I have seen very low success rates online for this treatment (30%) but when I asked his oncologist the success rate he said it was about 60%....I guess I would just like an honest opinion or some advice from people who have been through a similar process?

Also, it was mentioned that he had an aggressive tumor, which doesn't sound good to me. My dad is a fit, very active and otherwise healthy man, which makes the fact that he has cancer almost hard to believe if that makes any sense

Basically I want to how likely it is that my dad can beat this, or even to live with it for a long time?

I'd really appreciate any advice
Thank you
Posted 4/7/2012 4:31 PM (GMT 0)
I've always heard the 30% success rate too. The reason being the other 70% is systemic.
Posted 4/7/2012 4:34 PM (GMT 0)
Bally,

Firstly, welcome to the site. You will find a lot of information here, but most importantly, the compassion of people who are fighting the same fight.

There is a body of research available on your question, but the simplest way to answer it is to go to http://nomograms.mskcc.org/Prostate/SalvageRadiationTherapy.aspx and plug in your dad's numbers. But always remember - it is just statistics, people are individuals and everyone is different.

Best of luck to you and you dad.

Greg B.
Posted 4/7/2012 8:09 PM (GMT 0)
If the cancer is local (still in the prostate or prostate bed) salvage Rt is very successful, close to 100%. Overall, as Ziggy said, most reoccurrances are not local but systemic, cancer cells escaped into the blood or lymphatic system. The 30% overall success rate indicates the high degree of systemic disease that is beyond the radiation beam. The only way to confirm a local reoccurrance is to biopsy any remaining prostate tissue or the prostate bed.
Posted 4/7/2012 8:20 PM (GMT 0)
How is a biopsy of the prostate bed performed?  I've never read of this myself but am interested.  I've also read of the 30% success rate of SRT.  I admit that I don't know much about RT in general, but to me it just seems like you're just shooting radiation into one's body in hopes of hitting the cancer.  That just seems so wrong to me and so prone to error.  Am I incorrect in that assumption?

I guess I'm too much of a nuts & bolts, tab A goes into slot B, kinda guy.  I don't like maybe's, possibly's, and hopefully's.

Posted 4/7/2012 11:19 PM (GMT 0)
HD Rider,
I know Dr Bahn does this using a color doppler ultrasound to guide the biopsy. He can spot any prostate tissue left behind after surgery and biopsy that also. In the bed tumors need blood flow in order to grow, so he targets the areas of increased blood flow.
I agree with you that it doesn't make sense to go into localized salvage radiation unless there is some evidence to indicate that it is still local, such as a small positive margin on your pathology or indication that tissue was left behind, or a confirmation biopsy. That's just my opinion, but without any other data a 30% chance of cure is just too risky for me and I would go directly to HT with hopes that an early course could kill all the cancer cells where ever they are without risking the compounding side effects of radiation on top of a surgery. If I could identify the cancer even if it was in the nodes then I would do targeted radiation along with HT for a higher percentage shot of a cure.
JT
Posted 4/8/2012 12:35 AM (GMT 0)
I would hope that the success rate is better than 30%. My urologist said it was around 60%. Your Dad started SRT at a PSA of .3, which is pretty good. I'm guessing that your Dad's urologist didn't recommend SRT sooner because his PSA remained at .2 for three successive tests. I started when my PSA rose to .19. I will not say that mine has been successful for sure, but I am heading in the right direction. I cannot emphasize enough the importance of diet and exercise in the success of the treatment. I was disappointed with my first 2 post-SRT PSA's. I started walking 2-3 miles per day after New Years, and also cut way back on my fat intake and I dropped 18 lbs. I don't know if it was a coincidence or not, but my last PSA dropped from .14 to .081. Lots of people in this forum believe that exercise and diet have a big influence on the success of the treatment, and I have become a believer. Good luck to you and your Dad. Also, you reported his numbers in one decimal place. Have your Dad request a more precise test that goes to at least two digits.
Paul
Posted 4/8/2012 4:26 AM (GMT 0)
I would hope that the success rate is better than 30%. My urologist said it was around 60%.

the OP's dad had a beginning PSA of 19 and was never non-detectable.  i'm no doctor but i think 30% sounds more realistic than 60% in this case.  in any case there's a chance and i would try to dwell on that.  best of luck to you.

ed

 

Posted 4/8/2012 12:56 PM (GMT 0)
Bally also mentioned that the doctor did not get the entire prostate, so his PSA would never go to zero with a portion of the prostate left behind. The question is how much of the .2 and .3 readings are from benign tissue, and how much is from cancer.

Paul
Posted 4/8/2012 6:47 PM (GMT 0)
Recent studies both here and abroad have shown beyond doubt that by adding Hormone Therapy in conjunction with the radiation increases the success rate by a big margin, especially with aggressive (G-8, G-9) cancer. It seems the one-two punch of the combined treatment enhances the ability of the radiation to destroy all the cancer cells if they are still confined to the prostate bed....

Most men can tolerate a one year or 18 month period of HT without serious side-effects...
Posted 4/9/2012 12:50 AM (GMT 0)
This is not a simple fill in the blank question. If you take all people who had SRT, the 30 % is a fairly well established number supported by many studies.

If you factor in the patient's biopsy and pathology results, certainly you will find some who had a 100 % success rate, some who had a 70 % rate, and some who had a 50 % etc. There are so many variables.

That is the key for the oncologist to come up with a number. Hopefully your doctors have studied all of the factors to arrive at the 60 %. Beware of a doctor who just spouting big numbers.

Good luck to you. If the surgeon left some prostate tissue inside, I am thinking SRT is certainly logical, and may have higher odds of success if the PC has stayed in the bed. I would make sure they do full pelvic radiation, which would include the lymph nodes.
Posted 4/9/2012 10:56 AM (GMT 0)
Thanks to all those that replied, it is very helpful to get some advice

I asked the oncologist about the possibility of starting HT at the same time as SRT; it seemed to make sense to throw as much at it as possible.

he disagreed with HT at this stage, saying that it would make it impossible to see whether the RT actually worked as he wouldnt be able to tell if decreases in PSA were down to the RT or HT. He also said that he would prefer to keep HT until a later stage if needed. Does this make sense, or would we be better of pushing for an early start to HT??

The 30% published success rate for RT is very disheartening :( I suppose there is still a chance of success and I have to cling on to that.
Posted 4/9/2012 2:38 PM (GMT 0)
Bally,

It appears that your oncologist is not up-to-date with the latest studies. As Fairwind said, studies now show that HT combined with RT provide a significant increase in survivability. HT is usually started one or two months before the RT, as it takes about a month for the HT to bring the testosterone down to castrate levels. It's true that it would make it harder to see if RT was completely successful, but it would make it more likely. After 12-18 months of HT, you would then be able to let things proceed to see if there was a recurrence.

Keeping HT for a later stage does not make sense because at that point it can't be curative, only palliative. Right now is the only time that HT can contribute to curing the disease. You have to balance the chance for cure against "potentially" prolonged disease progression by waiting to use HT.

Your father's situation is a bit different from those in studies that talk about success rate, as some of the prostate was left behind. Given that fact, a PSA of .2 after surgery and a modest rise to .3 could be attributable to benign tissue. Even if some cancer was left behind, the growth rate does not appear rampant.

Of course, I'm not a doctor, so do some research to see if what we are saying makes sense to you.

Best wishes,
Nellie
Posted 4/9/2012 10:46 PM (GMT 0)
Thanks Riviere, we agree on this...Bally, I would PUSH HARD to include a years worth of HT started ASAP..The HT somehow enhances the radiation, makes it more effective, gives it a better chance, a 30% -50% better chance of working and achieving a cure...

YES, the HT will drop your PSA to (hopefully) zero very quickly and WILL mask whether or not the radiation was effective..SO WHAT?? After a year, HT is stopped, and THEN you find out whether the radiation was effective or not, but you will be another year down the road enjoying PSA 0..

To argue that you burned up a year of effectiveness off your possible future need for hormone treatment is just not so...If our cancer is going to proceed to termination, that termination date will be about the same either way... JMHO...
Posted 4/10/2012 9:26 AM (GMT 0)
Thank you for replying, the last two posts especially are making me wish I pushed the oncologist further to consider HT :(. we live in Ireland so I think maybe we are a little behind when it comes to the research and treatments....

Reading the side effects of HT I saw that it can increase cholesterol, and my dad has high blood pressure and cholesterol. I wonder if that is the reason that that they did not recommend the hormone therapy?

I mentioned it to my Dad last night but he just looked terrified at the thought of having any other sort of treatment put into the mix... he has gone for his second week of SRT now. I would like us to meet the oncologist to discuss adding in HT but he seemed strongly against it when I met him last, and I wonder is it too late to be adding it in now?
Posted 4/10/2012 1:33 PM (GMT 0)
Bally,

Assuming that your father is having the standard 8-week course in radiation, with two weeks already gone, the effect of HT would be significantly diminished at this point. Add to that the time it would take to get it instituted, such as convincing everyone, I'd say it's too late to have any but marginal effects unless radiation were complete stopped and restarted after the testosterone had become undetectable.

Another thought: actual castration as opposed to medical castration, might have fewer side effect, and have the same effect. For what it's worth.

Even so, don't despair. There are many new treatments in the works that promise to help your father should the radiation not do the trick. And given the knowledge that part of the prostate was left behind, you have good reason to hope that the cancer is still local and treatable with RT.

Best wishes,
Nellie
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