The immortal debate.

Top Line: With ultra-sensitive PSA tests widely available for close surveillance following prostatectomy, many people have landed on an “early salvage” approach as a solution to the decades long adjuvant-versus-salvage radiation debate.

The Study: That was fun while it lasted, but the gang’s back together again to reignite the debate. These prolific authors suggest, particularly when looking at very high risk pathology, that immortal time bias may be the only driver of small reported reductions in time to progression with the early salvage versus adjuvant approach. Now stay with us. Picture a man with a PSA rise to a level that would be considered progression (let’s say 0.4) over the 6 month period following surgery whose PSA wouldn’t have responded to either aRT or sRT. On the adjuvant arm, he would receive radiation post-op and be marked as progression at his first post-radiation lab check at roughly 6 months post-op. On the salvage arm, he would receive radiation within 4 months of his trigger PSA ≥ 0.2 (let’s say at 2 months post-op) and not have another lab check until as long as 3 months after his 2 months of radiation is delivered, meaning progression could be recorded as long as 10 months post-op. So the same man with the same disease course has “achieved’ almost double the time to progression with salvage radiation. Well that ain’t right. With that in mind, here's a multi-institutional retrospective analysis that includes 1383 men with post-prostatectomy adverse pathology (read: pN1, ECE and Gleason 8+, or invasion into seminal vesicles or adjacent organs).who received adjuvant (n=428) or early salvage (n=965) radiation. The kicker is, they excluded all men like the one above who never saw a decrease in PSA, i.e. the men who didn’t benefit from either approach. Alas, after propensity matching for systemic therapy, etc, all-cause mortality was significantly reduced among men receiving adjuvant versus early salvage radiation (HR 0.66), particularly when node-positive disease was excluded (HR 0.33).

TBL: Recognizing men with adverse pathology comprised at most 9%-17% of the enrollees in the three randomized trials designed to answer this question, we hope someone will still attempt a pooled analysis excluding “nonresponders.” | Tilki, J Clin Oncol 2021

Comments

  1. Hello to everyone out here, I am here to share the unexpected miracle that happened to me … My name is Susan Christian , I live in London, UK. we got married for more than 9 years and have gotten two kids. thing were going well with us and we are always happy. until one day my husband started to behave in a way i could not understand, i was very confused by the way he treat me and the kids. later that month he did not come home again and he called me that he want a divorce, i asked him what have i done wrong to deserve this from him, all he was saying is that he want a divorce that he hate me and do not want to see me again in his life, i was mad and also frustrated do not know what to do, i was sick for more than 2 weeks because of the divorce. i love him so much he was everything to me without him my life is incomplete. i told my sister and she told me to contact a spell caster, i never believe in all this spell casting of a thing. i just want to try if something will come out of it. i contacted Dr Emu for the return of my husband to me, they told me that my husband have been taken by another woman, that she cast a spell on him that is why he hate me and also want us to divorce. then they told me that they have to cast a spell on him that will make him return to me and the kids, they casted the spell and after 24 hours my husband called me and he told me that i should forgive him, he started to apologize on phone and said that he still love me that he did not know what happen to him that he left me. it was the spell that Dr Emu casted on him that make him come back to me today, me and my family are now happy again today. thank you Dr Emu for what you have done for me i would have been nothing today if not for your great spell. i want you my friends who are passing through all this kind of love problem of getting back their husband, wife , or ex boyfriend and girlfriend to contact Dr Emu , if you need his help you can contact him through his private mail: emutemple@gmail.com or you can contact him through his website https://emutemple.wordpress.com/ fb page Https://web.facebook.com/Emu-Temple-104891335203341

    ReplyDelete

Post a Comment

Popular Posts