Radiation with or without Antiandrogen Therapy in Recurrent PCa - a follow-up.

[pjoshea13]

New video interview [1] on follow-up to a 2017 paper [2].

In the "Shipley" study:

"... we assigned 760 eligible patients who had undergone prostatectomy with a lymphadenectomy and had disease, as assessed on pathological testing, with a tumor stage of T2 (confined to the prostate but with a positive surgical margin) or T3 (with histologic extension beyond the prostatic capsule), no nodal involvement, and a detectable PSA level of 0.2 to 4.0 ng per milliliter to undergo radiation therapy and receive either antiandrogen therapy (24 months of bicalutamide at a dose of 150 mg daily) or daily placebo tablets during and after radiation therapy."

The conclusion was that:

"The addition of 24 months of antiandrogen therapy with daily bicalutamide to salvage radiation therapy resulted in significantly higher rates of long-term overall survival and lower incidences of metastatic prostate cancer and death from prostate cancer than radiation therapy plus placebo."

The trial occurred 1998 through 2003. In today's world, men get salvage radiation at lower PSAs. A re-examination of the data shows that the survival benefit was largely in men with higher PSAs (which perhaps included men with undetected metastatic disease.)

"... the guys at low PSAs, a little more representative of today, all we saw was the morbidity, and so there's about a threefold increased risk of cardiac events, which translated into about a twofold increased risk in other cause mortality."

-Patrick

[1] urotoday.com/video-lectures...

[2] nejm.org/doi/full/10.1056/N...

[Ralph1966]

In my case, I got monthly injections of Firmagon for 6 months with SRT.