Anti-androgen therapy increase Mortality in select patients undergoing PCa Salvage Radiotherapy

[pjoshea13]

New study below [1].

"In 2017, the phase III NRG Oncology/RTOG 9601 clinical trial findings demonstrated that an additional 2 years of anti-androgen therapy added to radiation treatment following surgery in men with recurrent prostate cancer increased overall survival (OS). This outcome spurred the recent ASTRO/American Urological Association (AUA) recommendation for both radiation and prolonged hormone therapy following surgery for men with recurrent prostate cancer."

However, a "secondary analysis that parsed patients based on high and low levels of PSA revealed no OS benefit for men with low PSA levels after prostate surgery, and markedly increased risk of death from other causes."

From the 2017 RTOG 9601 paper [2]:

"The actuarial rate of overall survival at 12 years was 76.3% in the bicalutamide group, as compared with 71.3% in the placebo group (hazard ratio for death, 0.77 ...). The 12-year incidence of death from prostate cancer, as assessed by means of central review, was 5.8% in the bicalutamide group, as compared with 13.4% in the placebo group ... The cumulative incidence of metastatic prostate cancer at 12 years was 14.5% in the bicalutamide group, as compared with 23.0% in the placebo group ... The incidence of late adverse events associated with radiation therapy was similar in the two groups. Gynecomastia was recorded in 69.7% of the patients in the bicalutamide group, as compared with 10.9% of those in the placebo group"

From the new study [1]:

"Originally, the patients were randomized to a 2-year regimen of post-surgical radiation therapy plus a nonsteroidal anti-androgen (bicalutamide, 150 mg/day) or placebo. This time around, the patients were grouped based on their PSA levels before radiation (> 1.5 ng/mL, n = 118; ≤ 1.5 ng/mL, n = 642). As before, OS rates were improved when PSA exceeded 1.5 ng/mL ... But, for men with PSA levels ≤ 1.5 ng/mL, no OS benefit was evident ..."

"The researchers also looked at a subset of 389 patients with PSA levels ≤ 0.6 ng/mL. This level is closer to the present standard for post-surgical radiation treatment. These men were twice as likely to die from causes other than cancer when hormone therapy was added. The risk was more than fourfold greater when PSA levels were lowest (0.2–0.3 ng/mL, n = 148). These men were also more likely to experience severe cardiac events along with neurological problems (odds ratio 3.57 ...)."

-Patrick

[1] practiceupdate.com/c/89648/...

[2] ncbi.nlm.nih.gov/pmc/articl...

[Sxrxrnr1]

I had read this earlier today. Forwarded to a friend that has been on Lupron and Xtandi post RP and RT for several years. His PSA is undetectable. Had dinner with he and others at PCRI conference where this was a topic of discussion.

I often query him why. He says he is more comfortable. I tell him that will likely fail anyhow and possible damage he is doing to other critical bodily systems.

Perhaps this will get his attention.

I know others doing same for whatever their reasons.

Most of us cannot wait to get off these drugs, others seem to relish them.

[Break60 in reply to Sxrxrnr1]

Relish ADT”? The only ones who could possibly relish this garbage are the pharmaceutical companies who profit from its use.

I switched to estradiol patches earlier this year; what a difference!

Bob

[VictoryPC]

Great facts. Thank you

[Muchacho]

This describes my situation. I had a biochemical recurrence in January of this year with a .2 psa. Based on the recommendations of ASTRO and AUA from May of this year, I have undergone 4 months of Lupron, which has been harsh. I will be seeing my urologist next week and will take him this new information to get his input. It is disturbing that ASTRO and AUA did not interpret the studies correctly initially if an amendment of their recommendation is needed.