Dr. Patrick Walsh's Guide to Surviving Prostate Cancer Quotes

“(IMRT) has an advantage. The newer, high-dose, conformally directed, external-beam techniques for radiation therapy such as IMRT have been in widespread use for less than ten years; IGRT has been around for an even shorter time. However, some reports of long-term success are now emerging. New studies suggest that at ten years, high radiation doses alone can produce PSA control or cure rates in 93 percent of men with low-risk prostate cancer. What about more aggressive prostate cancer? As we discussed in chapter 9, the best treatment regimen for men with intermediate- and high-risk prostate cancer is still a moving target, but it will likely turn out to be a combination of high-dose radiation and short- or long-term hormonal therapy.”
― Patrick C. Walsh, Dr. Patrick Walsh's Guide to Surviving Prostate Cancer

“The clearest short-term yardstick may be the PSA nadir (discussed above). One study of 743 patients at Memorial Sloan-Kettering Cancer Center in New York confirmed that higher-intensity radiation does a better job of achieving a rock-bottom PSA level. Of the men who received higher doses—76 to 81 Gy—90 percent achieved a PSA nadir of 1.0 ng/ml or less; 76 percent of men who received 70 Gy and 56 percent of men who received 64.8 Gy achieved those low PSA levels. But there was a trade-off—the men who received higher doses of radiation also had a significantly higher rate of gastrointestinal side effects, urinary tract complications, and impotence. To overcome these side effects at high doses, intensity-modulated radiation therapy”
― Patrick C. Walsh, Dr. Patrick Walsh's Guide to Surviving Prostate Cancer

“overriding principles can be useful here in identifying the likelihood of metastases. If you have a high Gleason score (8 or greater), or if the PSA level begins to rise early after radiation therapy, or if the PSA level has a rapid doubling time, it is more likely that you have metastases than a local recurrence, and in this case, you should seek systemic therapy (see chapter 13).”
― Patrick C. Walsh, Dr. Patrick Walsh's Guide to Surviving Prostate Cancer

“that the radiation alone has not killed the cancer, this should be clear long before your PSA level reaches that point. However, it’s worth repeating that the consensus panel that developed the Phoenix definition (nadir + 2) advises, “Physicians should use individualized approaches to managing young patients with slowly rising PSA levels who initially achieved a very low nadir and who might be a candidate for salvage local therapies.” If your PSA level continues to rise, what should you do? To determine whether you are a candidate for surgery after radiation, you will need to have a prostate biopsy to confirm that the cancer recurrence is local; you will also need a bone scan and CT scan or MRI of the abdomen and pelvis to rule out the possibility that cancer has spread to distant sites. The guidelines above (see What Should I Do If My PSA Comes Back After Surgery?) may one day be adapted for men who have failed radiation treatment, but the”
― Patrick C. Walsh, Dr. Patrick Walsh's Guide to Surviving Prostate Cancer

“The purpose of radiation treatment is to disable the prostate, to stop cancer there from continuing to grow. Because the prostate is the source of PSA, if PSA continues to be made and its level begins to rise, there are two possibilities. Either the cancer has reactivated locally, within the prostate or surrounding tissue, or a distant metastasis—a tiny bit of cancer that probably escaped the prostate before treatment began—has started causing trouble.”
― Patrick C. Walsh, Dr. Patrick Walsh's Guide to Surviving Prostate Cancer

“need to have a prostate biopsy to confirm that the cancer recurrence is local; you will also need a bone scan and CT scan or MRI of the abdomen and pelvis to rule out the possibility that cancer has spread to distant sites. The guidelines above (see What Should I Do If My PSA Comes Back After Surgery?) may one day be adapted for men who have failed radiation treatment, but the overriding principles can be useful here in identifying the likelihood of metastases. If you have a high Gleason score (8 or greater), or if the PSA level begins to rise early after radiation therapy, or if the PSA level has a rapid doubling time, it is more likely that you have metastases than a local recurrence, and in this case, you should seek systemic therapy (see chapter 13).”
― Patrick C. Walsh, Dr. Patrick Walsh's Guide to Surviving Prostate Cancer

“rates”
― Patrick C. Walsh, Dr. Patrick Walsh's Guide to Surviving Prostate Cancer

“Physicians should use individualized approaches to managing young patients with slowly rising PSA levels who initially achieved a very low nadir and who might be a candidate for salvage local therapies” (see below). The Phoenix definition is the new standard measure of the success of radiation therapy. And even this isn’t the one-size-fits-all, perfect definition of biochemical failure for all men who have undergone radiation. Nor is there a single best approach if a man’s cancer does return after radiation (see What Happens If My PSA Goes Up After Radiation Treatment? below). The good news is that the longer a man’s PSA remains stably low after radiation, the less likely he is to have a return of cancer down the road. Some men wonder whether any healthy”
― Patrick C. Walsh, Dr. Patrick Walsh's Guide to Surviving Prostate Cancer

“oncologists met to discuss a replacement for the ASTRO definition. They decided to define treatment failure as a PSA level that has risen 2 ng/ml higher than a man’s PSA nadir (the lowest level it reached following treatment). This definition has been correlated more accurately with long-term results in all patients, and it takes into account such factors as hormonal therapy and the PSA bounce. Failure is now considered to occur when the PSA level reaches the nadir + 2 value. This is called the Phoenix definition. Still, it takes time to determine this value, so this equation should not be used to gauge the success of treatment in men with less than two years’ worth of PSA tests after radiation therapy. Furthermore, the consensus panel that developed this definition cautions,”
― Patrick C. Walsh, Dr. Patrick Walsh's Guide to Surviving Prostate Cancer

“of Urology, evaluated nearly five thousand patients from nine hospitals who had received external-beam radiation therapy alone and had been followed for an average of six years. This study, too, looked at how well the ASTRO criteria and other definitions could predict actual clinical failure (the development of distant metastases or the return of cancer in the irradiated prostate). Despite its stellar acronym, the ASTRO definition did not prove to be outstandingly superior; in fact, the researchers found, some of the alternate definitions of biochemical success or failure were slightly better. The Phoenix Definition In 2005, another panel of radiation”
― Patrick C. Walsh, Dr. Patrick Walsh's Guide to Surviving Prostate Cancer

“largest study to look at this phenomenon, involving nearly five thousand men who were treated with external-beam radiation alone, found that the PSA bounce did not seem to raise the risk of local failure or distant metastases. However, because of this PSA bounce, the ASTRO consensus definition may falsely identify some of these men as having a relapse—again, leading to unnecessary anxiety. Preliminary research using magnetic resonance spectroscopy imaging (MRSI) suggests that the bounce may actually be caused by inflammation of the prostate after radiation. MRSI is also being investigated as a means to determine whether what’s happening with a man’s PSA is a bounce, or a return of cancer. Another study, published in the Journal”
― Patrick C. Walsh, Dr. Patrick Walsh's Guide to Surviving Prostate Cancer

“of biochemical failure when he’s actually cancer-free. Finally, there’s the phenomenon of PSA “bounce”—and this, too, can confound results under the ASTRO definition. While PSA declines after radiation, men who are ultimately headed for a healthy, low, stable PSA level may see it suddenly go up. Think of it as PSA’s last fling. This bounce is transient and has been studied using a variety of different definitions. It is generally described as a sudden rise of at least 0.1 to 0.5 ng/ml, followed by a decrease. This usually occurs within the first two years after treatment, and may happen in as many as 40 percent of men after either external-beam radiation or brachytherapy. In most studies, it seems more likely to occur in younger men. The”
― Patrick C. Walsh, Dr. Patrick Walsh's Guide to Surviving Prostate Cancer

“Because it can take two to even six years for a man to reach his PSA nadir after radiation, this initial “false rise” in PSA level after the hormonal therapy ends might lead to needless worry from a wrongful diagnosis”
― Patrick C. Walsh, Dr. Patrick Walsh's Guide to Surviving Prostate Cancer

“cells die, but it’s a slow death. Patients who eventually turn out to fail treatment may see their PSA levels drop for months or even years after treatment, notes Song. “If the results are evaluated too soon, many patients can’t know whether their cancer has been controlled.”
― Patrick C. Walsh, Dr. Patrick Walsh's Guide to Surviving Prostate Cancer

“to measure success or failure. One criticism has been that PSA increases are not always consecutive. A man’s rise in PSA with one test might be followed by a transient decrease in the next, followed by another increase. Although there may be recurrent cancer, under the ASTRO definition, this man’s treatment would still be considered a success—even though it’s just a technicality. “Fortunately, any astute radiation oncologist will not blindly follow the consensus definition in making treatment decisions,” comments Danny Song. A quirk of the ASTRO definition is that, over a short period of time after treatment, it really can’t tell us much. This is due to the gradual nature of radiation’s effects; cancer”
― Patrick C. Walsh, Dr. Patrick Walsh's Guide to Surviving Prostate Cancer

“(ASTRO). As the name suggests, this was based on the agreement of a panel of experts, who in the 1990s met and chose to define PSA failure after radiation therapy as three consecutive rises in PSA (taken at least three months apart from each other) after it reaches its nadir—the lowest point PSA reaches after treatment. (PSA nadir is a key concept in radiation therapy for prostate cancer. Because radiation’s effect is gradual, it may take two or three years for PSA levels to hit rock bottom. Some men reach this nadir much more quickly—within months—and some men take much longer—several years. Ideally, once PSA has reached its lowest level, it should stay put.) Although the ASTRO definition has proven useful, it has not been perfect, and not all radiation oncologists agree that this is the best way”
― Patrick C. Walsh, Dr. Patrick Walsh's Guide to Surviving Prostate Cancer

“Over the last decade, the standard criteria for relapse, or biochemical failure, after radiation has been the consensus definition of the American Society for Therapeutic Radiology and Oncology”
― Patrick C. Walsh, Dr. Patrick Walsh's Guide to Surviving Prostate Cancer

“Instead, the most common strategy has been to watch the trend of PSA—to see what it does over time, with the idea that if it’s coming from benign tissue, the PSA level should remain stable, but if it’s coming from cancerous tissue, the PSA will creep back up as the cancer cells multiply.”
― Patrick C. Walsh, Dr. Patrick Walsh's Guide to Surviving Prostate Cancer