“If you remove the prostate, you’re cured. Right?”

Secondary treatment after prostate surgery linked to disease severity
By Sarah Guy
13 January 2010
BJU Int 2009: 105: 28–33

MedWire News: The likelihood that prostate cancer patients who experience biochemical recurrence (BCR) after radical prostatectomy (RP) will receive salvage therapy depends on the severity of their disease, where they were treated, and when they experienced BCR, study findings show.

Conversely, the US team reports that individual patient characteristics such as race, body mass index (BMI), and age did not predict the need for salvage therapy.

“Not all patients who develop BCR will need secondary treatment,” write Daniel Moreira, from Duke University in Durham, North Carolina, and colleagues in BJU International.

“However, patients with more aggressive tumors, characterized by high grade, stage, and a short prostate-specific antigen doubling time [PSADT] are candidates who theoretically derive most benefit from salvage therapies,” the team explains.

The researchers evaluated factors associated with time to secondary treatment among a cohort of 697 men who developed BCR after being treated with RP at one of five Veterans Affairs (VA) hospitals in the USA.

A total of 357 (51%) men received some form of salvage treatment (androgen deprivation therapy, radiotherapy, a combination of both, or observation) during a median follow-up time of 45 months. The 1-, 3-, and 5-year risk rates for receipt of salvage treatment were 29%, 48%, and 53%, respectively.

Multivariate analysis accounting for age, race, pathology Gleason score, BMI, treatment center, and calendar year of BCR showed that a more recent year of BCR, shorter disease-free interval, and high-grade disease (Gleason 8–10) were all significantly associated with the likelihood that a patient would receive salvage treatment.

More than 70% of patients who were originally treated before 1995 remained untreated 3 years after developing BCR, while less than 50% of patients originally treated after 2000 remained untreated within 3 years of BCR.

For the 361 (52%) patients with PSADT data available, those with a PSADT below 9 months were 2.63 times more likely to receive salvage treatment than men with a PSADT above 9 months.

An additional predictor for secondary treatment was the VA center the patient was treated in, even after adjustment for disease severity and patient characteristics. “Thus, it seems treatment decisions follow patterns of clinical practice within the institutions and geographical regions,” note Moreira et al.

The team concludes: “Although patients are being treated more aggressively in contemporary years, the effect on long-term survival is unknown.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

My thoughts-

Just as misconceptions abound regarding robotic vs. open prostatectomy, radiation vs. prostatectomy so to is there a misconception among patients about cure and prostatectomy. I am often told that a patient has chosen to remove the prostate because, ” I want to be done with it.” I am also commonly asked “How is it that the PSA could go up if you’ve had the prostate removed.”

First of all if all the cancer is in the prostate only, and you remove the prostate, you probably have a very high likelihood of being cured. If however, there is extension of your cancer to the capsule or through  it,  then you may not be cured. A PSA that rises after the prostate is removed indicates residual disease. The article above addresses this issue.

The tables and the link below allow the newly diagnosed prostate cancer patient to predict, on a percentage basis, the likelihood of extra-capsular spread and the potential need for radiation after surgery. Working through the Partin tables as it pertains to the specifics of your disease(both knowing your stage and the specifics of your PSA and biopsy parameters) will be very helpful to you in making your decision.


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