Saturday, May 10, 2014

Salvage Therapies and treatments

After primary treatments, a period of remission is followed until cancer cells start to resurface again. The period of remission will depend on the age, health and type and effectiveness of primary treatments. Five years remission is considered the gold standard, before failure situations occurs, followed by PSA anxieties.

Failure situations.
a.     A biochemical failure occurs when the PSA rises again but there is no visible evidence of cancer on the MRI/ CT scan, bone scan or any other imaging.
b.     Local failure occurs when PSA rises with the disease recurring in the area of the prostate gland.
c.      Distant failure occurs when PSA rises as metastases show up in other parts of the body.

Milestones to note
a.     Failure of EBRT is deemed when the PSA value of 2 ng/mL is greater than the absolute nadir it represents. Nadir is the lowest PSA value achieved post treatments and during remission.
b.     Biochemical recurrence post ERBT is seen in having more than 3 consecutive PSA risings after achieving PSA nadir.

The Phoenix Definition for cancer recurrence is nadir point plus 2 ng/mL. The definition is valid only after two years PSA test past radiation treatment. Nadir point is the lowest PSA reading after treatment. It is reached at 12 to 42 months after treatment should be under 0.5ng/ml and no further rise. (Phoenix definition. An annual conference of Oncologist defines cancer recurrence.) 

The value of PSA at 2 ng/mL plus PSA nadir (as in (a) above) is considered the gold standard when to take salvage therapies.

Options for salvage treatments
Salvage Therapies are the blanket term used for medical treatments when initial treatments failed.
These treatments may include:
a.     Salvage / Adjuvant radiation.
b.     Surgery (Radical Prostatectomy).
c.      Cryosurgery. (Freezing)
d.     High Intensity Focus Ultrasound (HIFU).
e.     Systemic treatment via hormone ablation.

Take care

Allen Lai

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