ADT effetiveness falls for Gleason 9 v. 8?

[hillndale]

Husband’s RP path report indicates SVI (seminal vesicle invasion) and EPE (extraprostatic extention—outside prostate). Confirms Gleason 9. So reading to prepare for meet with RO. But this study says ADT with EBRT is not effective for Gleason 9? He also has a lot of numbness, (fingers and all through his mouth??) wondering if that is just from DaVinci table, and will abate? Also am reading how important PSA velocity is, but other reports say Grade 5 doesn’t always show PSA?

ascopubs.org/doi/abs/10.120...

[hillndale]

Very encouraging, thanks. I Reread path report. Says nothing about ductal or inta-ductal. Did note it says perineural invasion present too. Impressed you did not have any radiation.

[NPfisherman]

Why wary of radiation for intraductal??

Fish

[Tall_Allen]

Database analyses like that are not useful in making such a decision, especially when better data are available. The biggest problem is "selection bias." The people with less advanced PC were more likely to do better with any therapy they were given, and they were given ADT because their doctors felt they would do better.

What you have to look at instead are randomized clinical trials (RCT) like DART 01.05 which clearly showed an advantage to long-term ADT in high risk patients:

thelancet.com/journals/lano...

But all this is moot because your husband is beyond the primary therapy stage. RCTs have shown that adding 6 months or more of ADT to SRT improved outcomes, but only among men who had PSAs over 0.7. it is a matter of judgment at what PSA ADT becomes useful, some ROs draw the line at 0.1, some at 0.5.

pcnrv.blogspot.com/2016/08/...

There is probably some trade-off between dose and ADT. Here are some questions you may want to discuss at your meeting:

pcnrv.blogspot.com/2017/12/...

[NPfisherman]

Did he have the axumin scan that you mentioned in previous posts??

[hillndale in reply to NPfisherman]

Yes, we were told the bone indications were ‘just osteoarthritis’ and that lesions in liver and kidney were ‘just old age’. It also indicated the cancer was in the prostate entirely-but the post rp report said all the cancer was on the right side...but not small. 4x2x2 cm was one of the measurements, the rest was ‘broken up’. The SV and vas were also ‘messy’ and broken off from prostate.

[NPfisherman in reply to hillndale]

Sounds like they believe it was contained within pelvic region and prostate area in particular....that is not bad news...that is good news (in the big scheme of prostate cancer)... Is he on ADT and are they going to do radiation ??

Fish

[hillndale in reply to NPfisherman]

We r attending a day long conference (swfl) Saturday and will decide.

[NPfisherman in reply to hillndale]

May God grant you the wisdom to make the right decision...good luck...