Hopeful result for no metastasis after BCR

Your situation is different - you are having a BCR after SRT. I think the median time to metastases is about 8 years after SRT failure. Here are a few clinical trials you can look into:

/pcnrv.blogspot.com/2016/12/recurrent-pc-non-metastatic-hormone.html

Pratoman-

This is a retrospective study, and it excluded men who were judged "at risk" enough to merit adjuvant or salvage treatment. So it's a group of very select men. On the average, their BCR took 3 years to show up, indicating indolent disease. It also included men with GS6. I disagree with you that "If that was the case, so many men would pass on SRT and just play the odds." Only those with life expectancy of less than 10 years would "play the odds." PC is almost always slow growing early on - this should not come as a surprise.

Prat-
It's just a convention that was useful at the time they came up with it. When an arbitrary value is widely agreed upon, it is used in many clinical studies in order to have comparable numbers. That's all there is to it. But the OP is talking about a whole different thing - a BCR after SRT.

Tall Allen said...
Your situation is different - you are having a BCR after SRT. I think the median time to metastases is about 8 years after SRT failure. Here are a few clinical trials you can look into:

/pcnrv.blogspot.com/2016/12/recurrent-pc-non-metastatic-hormone.html

Thanks, Allen. I'm trying to keep it real, and not put on rose colored glasses. But I'm not sure my having BCR after SRT would have kept me out of that retrospective study. You say it excluded men who were judged to be "at risk" enough to merit salvage treatment. But the stated population was:

"The median time to biochemical recurrence was 37.9 months. about 60% of these patients had extraprostatic disease, about 80% had a Gleason score ≥6, 5% had a Gleason score ≥8, and 35% had positive surgical margins."

My time to BCR after RP was 40 months, I had extraprostatic extension, a Gleason 7, and negative margins. So I'm in the sweet spot of their population.

I don't know why those men didn't have SRT or other adjuvant threatment, but I had it because it was available to me and recommended, not on the basis of high risk, but on the basis of, this is the next step in the protocol. If it had not been available, I suppose I would not have had it. In other words, on a risk-based basis, I was in the population that they would have followed up to the 40 month point, and would only have been excluded because I chose SRT. I realize common sense is dangerous with this disease, but it seems to me that having SRT should improve my outcome over what they found, rather than put me in a worse category.

Having said that, I find it hard to accept those findings because they run counter to the prevailing results from other studies. Since I don't have the full paper it may be that this was just a talk, or a poster session based on preliminary data. I have requested a full paper from the authors, if I get it I will post it or summarize it if it has copyright. I am meeting with my urologist/ oncologist next week and will ask him if he knows about this paper.

Thanks for the links to clinical trials. The link you posted was to an expired Prostvac trial but I found another one that is still open and will look into it. Here it is:
https://clinicaltrials.gov/ct2/show/NCT02933255

I've gone back through the paper and the numbers and I'm starting to make sense of it now. Both the paper and Tall Allen's comments make sense in terms of the context.

In the paper they refer to metastasis free survival after 10 years, in the context of time after RP. The mean time to BCR was 37.9 months, let's round that off to 3 years. So, if BCR was at 0.2, and the average doubling time was one year, the PSA would be at or just over 20 at the 10 year point, just the threshold for detectable metastasis. That's consistent with their 87.1% 10 year rate of freedom from metastasis. I suspect that if they had 15 year results the metastasis rate would be much higher.

With me, I've used up just about all of those 10 years from RP, but have had SRT. If SRT is effective in resetting the PSA clock, and my BCR is just starting at 0.2, then I'd be looking at 8 years to high risk of metastasis based on one year doubling, which is what TA said.

I know that ADT at this point would slow down the PSA but I don't know if it resets it or just masks it without lessening the cancer's aggressiveness. I also don't know how long one can live with metastasis. Some questions for my appt next week. I'll share the answers I get although I suspect they will be "we are not sure."

reachout said...
"You say it excluded men who were judged to be "at risk" enough to merit salvage treatment. But the stated population was:..."

It clearly states: "Patients who received neoadjuvant or adjuvant treatment were excluded." If, in the judgment of their doctors they needed additional treatment, they would, of course, have been given it. So these men were deemed to be "light" cases by their doctors and were watched instead of treated. And this is retrospective, introducing further selection bias.

Your case is very different. This does not apply to you.

Reach out
I find it disappointing that these retrospective studies never seem to stratify results by risk category. But you clearly were, in my view, low intermediate risk so you’re probably on the good side of the bubble in terms of prostate cancer specific survival. IMHO all we can do is treat our particular case as aggressively as is prudent weighing risks and benefits and hope for the best. Trying to glean the future by analyzing statistics is human nature looking for the time of our demise but suspect in terms of reliability especially given the continuous advancement in knowledge and treatment modalities .
Bob