I have been revisiting the issue of salvage radiation therapy (RT) since Ted just began this treatment last week. There isn’t a lot of good data (only “retrospective” data) about this, so when I first tackled this subject a few months ago I decided I was better off “reading the tea leaves”. But it seems that I may have overlooked some things (been too pessimistic!).
One thing that shocked me about reading this was: We know there’s a lot of stuff about PC that we don’t know. But I realize that there is critical info that we do know about, which, for some reason, is not being incorporated into clinical practice.
What I’ve found out is:
* Experts agree that post-RP radiotherapy is “underutilized”
* There is some evidence that RT may be effective even in men with advanced disease.
* Post-op RT should be started ASAP. It can make a big difference if the patient starts radiotherapy when their PSA is at .5 vs. 1.0, vs. 2.0. The differences can be really significant.
Also, the factors that have previously been considered critical for RT success may in fact not be so. MSK has recently developed a nomogram that is supposed to accurately predict the success of salvage radiotherapy (in the med lit they call this “sRT”). (Journal of Clinical Oncology, 2006 ASCO Annual Mtg. “Predicting the outcome of sRT for recurrent PC after RP”, by Stephenson, Scardino et al.)
And maybe “prophylactic RT” (adjuvant), should be done as a matter of course on high- and even medium-risk men. Salvage RT is also thought to work, but the results are not that clear.
There is a consensus that if RT is going to be given, it should be started sooner than later. *So why is it standard medical advice after a positive PSA to advise the patient to wait 6 mos. before doing anything? It just doesn’t make sense.
When Ted’s PSA started to rise back in January, I was advised by some “elders” online to seek help immediately, i.e