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Re: ASTRO recommendations for TURPs
>Refer to "Consensus statement: guidelines for PSA following radiation
therapy", Int J Radiation Oncology Biol Phys, 37: 1035-1041 (1997)
>
>Since ASTRO is an organization dedicated to therapeutic radiology and
oncology, the ASTRO consensus panel made no surgical recommendations such
as when to perform a TURP or prostatectomy after radiation therapy, but the
guidelines do state that biochemical failure is not sufficient
justification to initiate additional treatment. They define biochemical
failure as three consecutive rises in PSA after a PSA
>nadir. The frequency of PSA determinations should be every 3 or 4 months
after therapy for the first 2 years and semiannually thereafter.
>
>At the time of the statement, the panel had little evidence that any
definition of PSA failure was an adequate surrogate for clinical
progression or survival. There is growing evidence that their definition
of biochemical failure is highly correlated with various measures of
clinical failure (see IJROBP 41: 267-272 (1998)), but still no data that
radiation failures can be salvaged with prostatectomy.
>
>However, relieving a patient's obstructive symptoms with a TURP may or may
not affect biochemical failure. In the 1% of our patients who have
undergone this procedure after brachytherapy, we have managed to convince
all of them to delay the surgery until most of the radiation dose has been
delivered, > 3 half lives.
>
>Wayne
>
>--
>**********************************************************************
>
>Wayne M. Butler, Ph.D.
>Medical Physicist email: oncology@hgo.net
>Schiffler Oncology Center
>Wheeling Hospital phone: 304.243.3983
>1 Medical Park
>Wheeling, WV 26003 fax: 304.243.5047
>
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>
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