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Very early salvage

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Posted 4/2/2018 3:03 AM (GMT 0)
In another thread, Compilers thread on scans, which I didn't want to hijack, Tall Allen posts a link that leads to the following link

/pcnrv.blogspot.com/2016/09/very-early-salvage-radiation-has-up-to.html


Ta, in your link, you describe "very early Salvage" as "SRT commencing between .01 and .2".
How can .2 be considered very early Salvage? Further making this confusing, is the fact that .01-l2 seems like a very wide range. It would lead to n assumption that starting Salvage at one end or the other, of the range, gives the same likelihood of a good result.

Post Edited (Pratoman) : 4/2/2018 2:16:47 AM (GMT-6)

Posted 4/2/2018 5:08 AM (GMT 0)
It is only confusing because you did not bother to follow the link in that sentence. Tsk, tsk at your laziness.
Posted 4/2/2018 8:36 AM (GMT 0)
Ok wise guy. First of all, you didn't notice my more important error, which was my posting a link to the wrong blog article. I posted to the one in Mel's original post, which referred to scans, but I was referring to another of your blogs, which was linked to WITHIN that article. Tsk, tsk 😂. I've corrected that with bold above, along with the correct link.

With that said, I clicked the link you referred to which leads to the abstract of the actual study you were blogging about and it's just as confusing. In the conclusion, it states........ " Grouping all patients with pre-salvage radiotherapy prostate specific antigen 0.5 ng/ml or less may be inadequate to define early salvage radiotherapy and it has a relevant impact on ongoing and future clinical trials."....

Really? .5? That's scary. More important under the results section, it shows the group initiating SRT between PSA of .01 and .2 as getting optimal results.

All I guess I'm saying is it would have been more informative for the author of the study to look at the difference in result between say, 3 groups - one initiating Salvage at .01 - .05, another between .05 and .1, and a third between .1 and .2

I don't think many patients wait until .5 these days to initiate SRT, and even .2 seems outdated to me. Or am I wrong about that? Because I'd love to know if I could wait until .2 without taking on inappropriate risk

Post Edited (Pratoman) : 4/2/2018 2:39:24 AM (GMT-6)

Posted 4/2/2018 12:33 PM (GMT 0)
Prato, Good Morning I was checking out that new nomogram from Cleveland Clinic that TA had a link to sure don't like it!!!
Posted 4/2/2018 1:15 PM (GMT 0)
How are these studies relevant to the OP's situation? The study in the OP's link is based on men whose PSA never got to zero after surgery. They had measurable PSA on their first 3 month test.
Posted 4/2/2018 2:53 PM (GMT 0)
It's not necessarily related to my situation, that's not why I posted. But ironically, after I posted it, I got my latest PSA results (this morning- see thread on PSA results), so I guess it now does poly to my situation.

Where do you see that the study applied only to men with persistent PSA after surgery, I don't see that at all.
Posted 4/2/2018 4:32 PM (GMT 0)

Pratoman said...


Where do you see that the study applied only to men with persistent PSA after surgery, I don't see that at all.

“They were all discovered to have detectable PSA following prostatectomy. “


The purpose of the study from the study itself.....

Purpose:

Early salvage radiotherapy following radical prostatectomy for prostate cancer is commonly advocated in place of adjuvant radiotherapy. We aimed to determine the optimal definition of early salvage radiotherapy.

www.jurology.com/article/S0022-5347(16)31206-X/abstract

I'm reading this study as a comparison between adj. radiation (due to "detectable PSA following prostatectomy"....VS.....waiting...

Why would the study mention adjuvant radiation if it were'nt discussing measurable PSA after surgery?
Posted 4/2/2018 4:39 PM (GMT 0)
IT- They meant "They were all discovered to have detectable PSA following prostatectomy at some point."

Prat - I think I can unpack it for you. First, recognize that you and I are way ahead of customary practice on this subject. Most men do not get uPSAs after prostatectomy, and are treated much later than you suppose. The whole reason the authors conducted the study was because they agreed with us that customary practice treats too late. The median PSA at the time of SRT was 0.4. That's why they chose 0.5 as the cutoff. Only 28% of the men were treated while their PSA was below 0.2. There would have been too few to split that into 3 subgroups and still be to be statistically valid. 43% of the men were not treated until their PSA had climbed over 0.5.
Posted 4/2/2018 9:21 PM (GMT 0)
ThanksmTA. Makes,sense now. Unbelievable numbers, can't imagine waiting that long to,treat. I guess we have to remember that HW members are an exceptional group.

Now that would be an interesting study, lol
Posted 4/3/2018 1:24 AM (GMT 0)
This discussion makes me nervous. The lab I have been going to only tests down to <.1. Should I be getting an sensitive PSA test that goes down to .01 ? I will not see any rise until it hits .1. I like to be informed.
Posted 4/3/2018 1:36 AM (GMT 0)
Good conversation to follow. It does seem to me that HW has the benefit of some very well informed posters.
Oldbeek, my post RP psa tests have been ultrasensitive from the first at six weeks, when it was .1 (“not what we hoped for,” said the surgeon). Then .11 at twelve weeks, .12 at eighteen, and still .12 at twenty-one and a half weeks. I wanted the most precise information available (recognizing lab or operator errors are possible) because of the EPE. Since my persistent psa seems to be growing slowly, early SRT hopefully will work.
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