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Had radiation, or surgery then radiation, but my PSA has started rising – how long will I last?

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JimJimJimJim    12
JimJimJimJim

Had radiation, or surgery then radiation, but my PSA has started rising – how long will I last?

[if you are at a later stage in your disease, you may wish to visit:
Due to start docetaxel chemotherapy, then Zytiga (abiraterone). How long will I last?]

Jim Marshall (not a doctor) said ...
Men are often frustrated when their doctor gives them a real answer – "Nobody knows!" or "Many men are alive many years later".

Some men pessimistically imagine a very short time.

While this may be true for a few unfortunate men, the following extract of a paper by Crook and her colleagues in Canada will give you some feel for how long it might be.

Men in this study had rising PSA after radiation.

  • Some of the men had had radiation as their primary treatment.
  • Some of the men had had surgery as their primary treatment, and were give radiation after that failed.
  • All men went on hormone therapy (also called ADT, Androgen Deprivation Therapy) when their PSA started rising after their radiation.
  • Some men had ADT on and off (intermittent). Others had ADT continuously.

So how long?
It turned out that half the men (median) were still alive 9 years after starting ADT following rising PSA after radiation.

Of those who died in the first seven years, fewer than 1 in 5 died of prostate cancer – more than 4 out of 5 had died of something else.

So, knowing this, you can increase your odds – look after your general health, especially your heart with good eating, and good (doctor advised) exercise.

(I may repost this same extract at a later time highlighting what it may tell us about intermittent vs continuous vs active surveillance)
... end Jim

N Engl J Med. 2012 Sep 6;367(10):895-903.
Intermittent androgen suppression for rising PSA level after radiotherapy.
Crook JM, O'Callaghan CJ, Duncan G, Dearnaley DP, Higano CS, Horwitz EM, Frymire E, Malone S, Chin J, Nabid A, Warde P, Corbett T, Angyalfi S, Goldenberg SL, Gospodarowicz MK, Saad F, Logue JP, Hall E, Schellhammer PF, Ding K, Klotz L.

Source
British Columbia Cancer Agency, Cancer Centre for the Southern Interior, 399 Royal Ave., Kelowna, BC V1Y 5L3, Canada. jcrook@bccancer.bc.ca

Abstract

BACKGROUND:
Intermittent androgen deprivation for prostate-specific antigen (PSA) elevation after radiotherapy may improve quality of life and delay hormone resistance. We assessed overall survival with intermittent versus continuous androgen deprivation in a noninferiority randomized trial.

METHODS:
We enrolled patients with a PSA level greater than 3 ng per milliliter more than 1 year after primary or salvage radiotherapy for localized prostate cancer. Intermittent treatment was provided in 8-month cycles, with nontreatment periods determined according to the PSA level. The primary end point was overall survival. Secondary end points included quality of life, time to castration-resistant disease, and duration of nontreatment intervals.

RESULTS:
Of 1386 enrolled patients, 690 were randomly assigned to intermittent therapy and 696 to continuous therapy. Median follow-up was 6.9 years. There were no significant between-group differences in adverse events. In the intermittent-therapy group, full testosterone recovery occurred in 35% of patients, and testosterone recovery to the trial-entry threshold occurred in 79%. Intermittent therapy provided potential benefits with respect to physical function, fatigue, urinary problems, hot flashes, libido, and erectile function. There were 268 deaths in the intermittent-therapy group and 256 in the continuous-therapy group. Median overall survival was 8.8 years in the intermittent-therapy group versus 9.1 years in the continuous-therapy group (hazard ratio for death, 1.02; 95% confidence interval, 0.86 to 1.21). The estimated 7-year cumulative rates of disease-related death were 18% and 15% in the two groups, respectively (P=0.24).

CONCLUSIONS:
Intermittent androgen deprivation was noninferior to continuous therapy with respect to overall survival. Some quality-of-life factors improved with intermittent therapy. (Funded by the Canadian Cancer Society Research Institute and others; ClinicalTrials.gov number, NCT00003653.).

Comment in
Androgen deprivation--continuous, intermittent, or none at all? [N Engl J Med. 2012]
PMID: 22931259
This extract can be found on http://PubMed.com, and is in the public domain.
On PubMed.com there will be a link to the full paper (often $30, sometimes free).
Any highlighting (except the title) is not by the author, but by Jim Marshall.
Jim is not a doctor.

 

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