Estimation of PSA Half-Life Following Salvage Radiation Therapy

Background:?We aim to estimate prostate-specific antigen (PSA) half-life after salvage radiation therapy (SRT) in patients with detectable PSA after radical prostatectomy (RP). Methods: A total of 272 patients treated with salvage radiotherapy between July 1987 and July 2010 were included in this IRB approved retrospective analysis. The median pre-salvage radiotherapy dose was 0.6 ng/mL (range, 0.2 - 21.9 ng/mL), 47 patients had at least a minimum tumor stage of T3b, 29 had a Gleason score over 7, and median dose was 66.6 Gy (range, 54.0 - 72.4 Gy). Results: The estimated PSA half-life in our cohort of patients was 3.0 months (95% CI, 2.9 - 3.2 months;range, 0.5 - 28.5 months). There was no evidence of a statistically significant association between PSA half-life and any baseline clinicopathologic characteristics. The median interval between individual PSA measurements was noted to be 4.6 months (range, 0.1 - 20.4 months). The median interval from the start of radiation therapy to the nadir PSA was 6.3 months (range, 1.3 - 79.1 months). PSA half-life remained approximately 3.0 months when accounting for infrequent and outlier PSA values. Conclusion: The PSA half-life after definitive RT has been reported to be approximately 1.6 months. Our analysis found the PSA half-life after SRT to be approximately twice that of patients treated with definitive RT. These results provide useful information to radiation oncologists when counseling patients both before and after SRT regarding expectations about PSA measurements.

Physician versus Patient Perception of Physician Hospital Discharge Communication: A Preliminary Study

Background: Physician discharge instructions are critical to patient care because they are the link transitioning the hospital care plan to the home. We hypothesize that physician perception of discharge instructions communication is better than patient perception. Objective: In a preliminary study, to compare patient and physician perception of communication at discharge. Design: Observational, survey-based. Setting: 330-bed adult teaching hospital. Participants: Surveys were mailed to 100 patients discharged home and 49 internal medicine physicians responsible for those patients’ care. Each physician had between 1 and 4 patients surveyed. Measurements: Patients and physicians received anonymous 5-item questionnaires concerning physician communication at discharge. Patient surveys inquired about their physicians’ communication at the specific physician encounter, while physician surveys asked about the physicians’ overall self-perception of discharge communication skills. Results: Completed questionnaires were returned by 59 patients and 40 physicians. Physicians reported a noticeably better perception of communication than their patients regarding spending adequate time reviewing the discharge plan (83% vs. 61%, P = 0.027), speaking slowly enough to understand (98% vs. 80%, P = 0.013), using wording that could be easily understood (100% vs. 68%, P P = 0.008). Perception of discharge communication improved with physician experience for several survey items. Conclusions: This study provides evidence suggesting that physician perception of communication at discharge is better than patient perception. Future studies of larger sample size and direct patient-physician pairing focusing on patient satisfaction and outcomes are needed.