Salvage Radiation Treatment

Salvage Radiation Treatment (salvage radiotherapy) is considered a first-line treatment that may be recommended for prostate cancer. Researchers have indicated from recent studies, that survival rates increase after radiation if conducted within 2 years from the onset of cancer, with no significant effects for those conducted after 2 years.

Definition

• Salvage Radiation Treatment is an external beam radiation, which can be used on patients who have had prostate surgery, yet have experienced a recurrence. Based on statistics, approximately 30 percent of people who have had the surgery will likely experience a recurrence of the disease within 10 years. Salvage Radiation Treatment can also be used after an individual has received hormone therapy for a few months.

When used?

• Salvage Radiation Treatment is used when the PSA (prostate specific antigen) level increases, which indicates that the cancer has returned. This PSA level is a protein that is blood-based, and released by the prostate.

Positive Results

• Johns Hopkins studies revealed that the radiation not only reduces the disease progression, but is three times more likely to increase the possibility of the individual surviving at least another 10 years. The survival rate increases by 86 percent, if the radiation is conducted within two years, compared to 62 percent, if it is conducted after two years. The Salvage Radiation Treatment is very effective, with faster-growing cancers, and in many cases people live longer, and recurrences are eliminated.

The First Procedure

• With an increased PSA level, the patient must first undergo a transrectal needle aspiration biopsy of the urethrovesicle (uv) junction anastomosis.The biopsy is significant in diagnosing prostate cancer, when it is clinically suspected, or the PSA level is elevated, a sign of recurrence of the disease. This is an outpatient procedure. It involves the use of a 18-gauge spring loaded needle, which is used to remove tissue sample, to confirm the presence of cancer cells.

The Effect

• Salvage Radiation Treatment has increased survival rates, when patients have a recurrence after a radical prostatectomy. Positive results increase when this procedure is done within the first 2 years of recurrence.

  Previous studies conducted revealed that radiation treatments reduced the progression of recurrent prostate cancer, and John Hopkins studies conducted later, revealed that radiation also increased survival rates.

Benefits

• The Gleason Grading System generates a Gleason score, which is used to determine the stage, and grade, of the prostate cancer. A microscopic study conducted on the tissue removed during the biopsy is used to determine the score. The pathologist assigns a number between 1-5, based on the pattern of the cells that are most common. The pattern of cells which is the second most common, is also assigned a number between 1-5. The sum of these two numbers is the Gleason score. It ranges between 2-10. Most prostate cases score either 5, 6 or 7, with more aggressive cases scoring 8, 9, or 10. Scores below 4 are rare, because a biopsy is often not conducted at that level.

  The surgical margin represents the outer section of the tissues, removed during surgery. It has been reported that 20 percent of patients with a positive surgical margin (PSM), will suffer from a recurrence of the disease, and approximately 15 percent of these individuals will progress to metastatic stages.

  The PSA doubling time (PSADT) is the time the takes for the PSA to double. Both the PSA and PSADT are significant factors that determines how the disease progresses, and the survival rates of men diagnosed with prostate cancer.

  Studies conducted by Stephenson's et al revealed that even those individuals with a Gleason Score of 8-10, a negative surgical margin, or a doubling time of the PSA below 10 months, has a 1-5 potential of achieving a long-term progression-free response. This is if the radiation commenced when the PSA level is less than 2.0 ng /ML.

Prime Candidates

• An individual recommended for Salvage Radiation Treatment is someone who has a PSA value with a Gleason Score of 8-10, the surgical margins are positive, extra capsular extension is in existence, and no evidence of cancer is in the seminal vesicles.