Factors that determine prognosis for Prostate Cancer

brainman · Last edited by brainman on Wed Nov 28, 2007 6:24 pm; edited 1 time in total

Hi everyone. The question of a return of PSA after a total Prostatectomy has come up several times in the last few months and again just today. I did some research and this is what I found:

In an article in the Journal of the American Medical Association reporting on a study done at John Hopkins Medical Center in Baltimore, only prostate cells produce PSA. However, on average it took 8 years for the metastasis to show up and cause any problems. According to the authors of that article, in consultation with your medical team, you have two options:

1. Begin Hormone Therapy
2. Wait until the cancer reappears on scans

There seems to be four factors to consider in making a decision:

1. Is the PSA above 0.2?
2. Was the original Gleason score 8 or higher?
3. Did the PSA return in less than 2 years?
4. How fast is the PSA rising? Is it doubling in less than 10 months?

All of these seem to be negative indicators, that is, depending on the answer to these questions, hormone treatment should begin soon. The link below has all the details including a way to balance the above factors in order to determine how likely it is for you to develop a metastatic prostate cancer.

You can find more detailed information at: http://www.phoenix5.org/Basics/psaPostSurgery.html

Reference: Pound, CP; Partin, AW; Einsenberger, MA; Chan, DW; Pearson, JD; and Walsh,PC. ''New Method to Assess Risk of Advanced Cancer After Prostate Removal,'' Journal of the American Medical Association, Vol.281, pp.1591-1597.

I hope you find this information helpful.
_________________
Jim
Site Administrator and long-term cancer survivor
1992 Astrocytoma grade 2, left motor strip
2005 Recurrence this time said to be an Oligodendoglioma grade 3, same location.
My Story Part 1: http://cancerforums.net/viewtopic.php?p=7350
My Story Part 2: http://cancerforums.net/viewtopic.php?t=8029
Blog http://jimhawkinsport.blogspot.com/

Replicant · Moderator Joined: 01 Nov 2006 Posts: 178

Hi--

When you write about the two options, you fail to mention salvage radiation.

It is mentioned on the Phoenix5 website, and in the JAMA article "Risk of Prostate Cancer–Specific Mortality Following Biochemical Recurrence After Radical Prostatectomy". (Assuming that's the article to which you refer).

In the JAMA article, men who had complete responses to salvage radiation were considered--for the purpose of the study--cured and were then excluded from the study. So the two choices of wait or start ADT come AFTER the participants had the chance to try radiation.

Somewhere around 50% of men will get at least a durable response of several years--and may potentially be cured--by salvage radiotherapy after having PSA rise after prostatectomy. These days the side effects, though still present, are much milder with the advent of IMRT, image-guided IMRT, and protons.

Dr. Andrew Stephenson is a lead researcher in this field. He recently, along with these estimable co-authors: Scardino, Kattan, Slawin, and Pollak, et al., did a very large study of 1,600+ patients from 1985 to 2005. They did a multivariate study of all the factors that might affect the success of salvage therapy. The article, "Predicting the Outcome of Salvage Radiation Therapy for Recurrent Prostate Cancer After Radical Prostatectomy" (Journal of Clinical Oncology, May 2007), provides a nomogram for patients and doctors faced with a rising PSA after prostatectomy.

I had salvage IMRT done, and as I was considering it, became acquainted with a patient at Loma Linda UMC having proton beam salvage. He had negative margins, I had positive. Both of us had short (3 mos. or so) PSA doubling times. Both of us have seen our PSAs fall back to undetectable levels after radiation.

I'm quite relieved that I was able--at age 44--to have a second chance. I wasn't ready to sit back and wait for metastasis or go on ADT.

On my blog at http://pcabefore50.blogspot.com , I chronicle what it's like to be young and have prostate cancer, and what IMRT salvage was like. I also summarize and link to research on predicting the outcome of salvage.

Thanks for running a great board---I mean this to be informative and not an attack.

brainman

No attack felt. Thank you for that clarification. I did not "fail to mention" salvage radiation... the authors of the website your the summary of the study can be found did not mention that significant fact.

Again, thank you for that excellent review and clarification.

I did check out your website. Although normally you can only post links to external sites after being a member for over one month and posting at least 10 significant messages, there is one exception and your link qualifies: links to truly person, cancer related, blogs or websites.

I is good to have someone so well informed as part of this community Smile

.
_________________
Jim
Site Administrator and long-term cancer survivor
1992 Astrocytoma grade 2, left motor strip
2005 Recurrence this time said to be an Oligodendoglioma grade 3, same location.
My Story Part 1: http://cancerforums.net/viewtopic.php?p=7350
My Story Part 2: http://cancerforums.net/viewtopic.php?t=8029
Blog http://jimhawkinsport.blogspot.com/

bcdoo · Regular Joined: 09 Feb 2008 Posts: 18 Location: Texas

Thanks for the information. Is there any pre-emptive action one could take? I had Da Vinci, radical prostectomy 1/22 and the cancer was upgraded to 4+4....the path noted the cancer was stained to the margin. Should I be exploring any proactive measures or wait to watch PSA velocity?

Thanks...this is a great forum for us newbies!

BDOO

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