2018 ASTRO: SPPORT Trial: ADT With or Without Pelvic Lymph Node Radiation in Prostate Cancer

[JavaMan]

Last Fall, a study was presented in Atlanta GA, I believe, about a new approach (earlier treatment) to treatment with rising PSA following prostatectomy by Alan Pollack, MD, PhD, Chair of Radiation Oncology at the University of Miami and Deputy Director of the Sylvester Comprehensive Cancer Center.

ascopost.com/News/59414

The study has not yet been published yet but produced the following:

At 5 years following treatment, Freedom From Progression rates in the interim analysis group were

• 71.1% for PBRT alone (Prostate Bed Radiation Therapy)

• 82.7% for PBRT+ADT (Androgen Deprivation Therapy - hormone treatment)

• 89.1% for PLNRT+PBRT+ADT. (Pelvic Lymph Node Radiation Therapy)

At 8 years, distant metastasis found in:

• PBRT only - 45 patients

• PBRT+ADT - 38 patients

PLNRT+PBRT+ADT - 25 patients

It sounds like this will become the new treatment protocol for this scenario. It is the path I am now starting myself following my prostatectomy in November 2018.

Hopefully this will be helpful to someone.

[Tall_Allen]

It's not about earlier treatment. It's about using salvage radiation _ short-term ADT on the pelvic lymph nodes when there is biochemical recurrence after prostatectomy. In fact, those treated while their PSA was still very low did not benefit from whole pelvic radiation

pcnrv.blogspot.com/2018/10/...

[JavaMan in reply to Tall_Allen]

I thought I had read that past practices were to wait until later stages but this indicated an earlier treatment. What is considered "very low" PSA that would not benefit? I looked for that when first reading the article but nothing was defined.

[Tall_Allen in reply to JavaMan]

No, that was not the purpose of this study, and it is not standard of care to wait for later stages. They haven't yet published what they considered "very low." The minimum allowed PSA was 0.1; the maximum was 1.0.

[Spaceman210 in reply to Tall_Allen]

Have you seen any further stratification of the data set somewhere, beyond what is here?: astro.org/ASTRO/media/ASTRO...

For example it does not even list the number of participants with each Gleason grade. It seems to me the results could be very skewed if there were a lot of G6's in the population.

[Tall_Allen in reply to Spaceman210]

It was just an early presentation at a conference. Results weren't expected for another 2 years. Read the first sentence:

pcnrv.blogspot.com/2018/10/...

Also, pay attention to the caveats at the end.

[sharpcut in reply to Tall_Allen]

Tall Allen I am on similar path

Prostatectomy 8/18 ...........PSA 4 straight rises to. .12

RO. wants to start ADT for 6 months

Lupron and Casodex for1 month prior to radiation Prostate Bed Pelvic Lymph Node.

MO consult was not that helpful just agreeing with RO

I see conflicting data on this

Thank You for your time

[Tall_Allen in reply to sharpcut]

I agree that it is not a good idea to see an MO when one is pursuing curative therapy.

What is the conflicting data you are seeing?

[sharpcut in reply to Tall_Allen]

Hi Tall Allen. Thanks for your time conflicting treatment advice RO wants ADT

Astro Study. Says not helpful maybe even harmful. What’s your take ?

(knowing you are not giving medical advice )

[Tall_Allen in reply to sharpcut]

All I know is in the links I provided above.

[sharpcut in reply to Tall_Allen]

ok Appreciate your time. Just spoke to RO He said he understood That I wanted to "hold off" on Hormone Therapy. He said he just treated a Dr who requested the same so I think I am going with Radiation of Prostate Bed with Pelvic Lymph nodes

8 weeks

He also Agreed Based on all my data I should not have recurred but this will hopefully "cure" if there is such a thing thanks

[Davidl3940]

ascopost.com/issues/novembe...

[Kittenlover50]

For me, a good read. Bill had the triple one. Plus radiated all the way up to nipple line as that is how far it went.... he is going on 5 years in a couple months.... 8 might be looking good. ( he had also had chemo, zytiga prior to radiation. ).

[sharpcut]

Java man. Curious as to an update on your Journey ? I am on similar path

Prostatectomy 8/18 PSA 4 straight rises to. .12

RO. wants to start ADT for 6 months Lupron and Casodex for 2 months Then Radiate Prostate Bed Pelvic Lymph Node. Not sure what is best ?

Thank You for your time

[JavaMan]

Sharpcut, I had 3 rises in PSA after my 11/18 prostatectomy. Starting around April ‘19 I think, I did radiation on the prostate bed and lymph nodes for 40 days while simultaneously on Lupron for a 6 month period. That ended in August or September. I have had 2 PSA tests since then, October and December. Both have been undetectable. I have another in March. The December test is believed to be totally free of Lupron but I will feel better after my upcoming March test.

As far as your comment of not sure what is best, what are your alternatives to this?

[sharpcut]

Hi JavaMan,

Thank You so appreciate your reply Just spoke to RO He said he understood That I wanted to "hold off" on Hormone Therapy. He said he just treated a Dr who requested the same so I think I am going with Radiation of Prostate Bed with Pelvic Lymph nodes as well for 8 weeks

He also Agreed Based on all my data I should not have recurred but this will hopefully "cure" if there is such a thing. thank you. brother

[JavaMan in reply to sharpcut]

Sharpcut, my understanding, which is limited, is that the ADT may help weaken the cancer cells making it easier to kill with radiation. I believe this was the last curative option. I just turned 54 this month and did not want to use the ADT due to its suppression of testosterone and impact sexually. That was impacted but with the help of a few little pills, not eliminated. I did both the radiation and ADT simultaneously and am happy that I did with the undetectable results so far. My T level is rising again thankfully. I am regaining my own desire and function but still taking the sildenafil. I had debated doing just the radiation but thought if both was the better option for a cure, I was going to do it and hopefully get cured.

Not sure if your issues are similar but I don’t regret the decision at all. Best of science and luck to you!

[JavaMan in reply to sharpcut]

By the way, all my data suggested that I should have been cured with the surgery alone as well. My fist psa post-surgery may have been .05, then the next two at .07ish. It sucks having to make these decisions. Best of luck with yours.

[sharpcut]

Yes adds stress to every part of our lives. As far as ADT with Radiation. Here is Tall Allen's response to that exact question recently

""Evidence is that for favorable intermediate risk PC, adjuvant ADT does not improve results.

However, potency is no more at risk from the adjuvant ADT than it is without it. ADT affects libido, not potency".

I am using same pills 20 mg sildenafil every night. sometimes a challenge dose as well. I also inject one a week or ten days for the gigantic effect just to get max blood flow with helps keep equipment healthy

Thanks Brother

[JavaMan in reply to sharpcut]

Got it. Thanks.