Tracks 1-2
DR FREEDLAND: This patient had an undetectable PSA for approximately five
years, and then it began slowly rising. Now, at age 75, it’s at 1.0 ng/mL with a
two-year doubling time, and he’s anxious to know whether he should undergo
radiation therapy.
DR ROACH: I have two patients like this who had surgery some time in the
distant past by good surgeons, and they had slowly rising PSAs for a number
of years. With both patients, when their PSA levels rose to approximately
1.0 ng/mL, we treated them with radiation therapy.
One of these patients was surprised because he thought his prostate cancer
couldn’t recur since he had undergone prostatectomy. I shared with him
Stephenson’s data and showed him that the higher the PSA was at the time the
patients underwent radiation therapy, the higher the failure rate (Stephenson
2005, 2007). He reviewed his PSA and decided to proceed with radiation
therapy, not wanting to wait until his control rate would be lower.
DR LOVE: What about the combination of hormone therapy and radiation
therapy for these patients?
DR ROACH: For a number of years, we have been combining radiation therapy
with neoadjuvant hormone therapy for these patients, and I believe at least
three good studies now suggest that it may be the right thing to do. The data
from Memorial by Katz and colleagues showed that for patients who were
failing, those with adverse pathologic features experienced better PSA control
if they received neoadjuvant hormone therapy (Katz 2003).
Stanford conducted a study on approximately 100 patients who received six
months of hormones and radiation therapy versus none, which demonstrated a
trend for survival (King 2004). Even more recently, a Stanford paper suggested
that neoadjuvant hormone therapy with whole pelvic radiation therapy results
in a substantial improvement in the PSA control rate in the salvage setting,
which we have been doing for a number of years (Spiotto 2007).
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