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"Predicting The Outcome Of
Salvage Radiation Therapy For Recurrent Prostate Cancer After Radical
Prostatectomy, (JCO, May 2007)
(July 2007)
This
very useful and authoritative resource by Stephenson and 19 other well
known prostate cancer experts (including Dr. Dan Lin, UW) is based on
follow-up of 1540 patients from 17 North American tertiary referral
centers. The article provides a nomogram giving 6-year progression free
probabilities that integrate the weighted contribution of 11 standard
clinical variables. The overall message is now well recognized: the
earliest institution of salvage radiation therapy (SRT) after
established PSA recurrence yields the best outcome. "Before SRT, all
patients had a PSA level of 0.2 ng/mL or higher at least six weeks after
RP followed by another higher value, or a single PSA of 0.5 ng/mL or
higher."
Regarding the morbidity of SRT: "Mild to moderate acute
rectal and genitourinary toxicity is seen in the majority of patients,
but the reported incidence of acute grade 3 or 4 complications is less
than 4%. Late grade 1 to 2 rectal and genitourinary toxicity are
reported in 5% to 20% of patients, and late grade 3 toxicity is less
than 4%."
An accompanying graph plots the proportion of men free of
progression against the time in months from salvage radiotherapy
according to four PSA ranges - 0.50 ng/mL or less; 0.51 to 1.0; 1.01 to
1.5, and more than 1.50. The proportion free of progression at 6 years
associated with those ranges were: 48%; 40%; 28%; and 18% respectively.
But the real value of their analysis lies in the nomogram which allows
individualization of probable outcome by integrating a patient's values
for the 11 parameters entered onto a continuous variable scale. The
authors note that salvage XRT is conventionally recommended to patients
estimated to be at low-risk for recurrence, but "Our study demonstrates
that select patients with a short PSADT or Gleason grade 8 to 10 cancer
may also benefit from SRT.
Dr. Kattan said that
this nomogram will be soon be available on-line at "www.nomograms.org."
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