ADT Duration After Prostate RT for mPCa (distant metastases)

[6357axbz]

The established standard for ADT duration after prostate radiation for non-metastatic, localized high risk PCa is 18 months. My RO has me going on intermittent ADT stopping the ADT 6 months after RT. I have distant oligometaststic (bones) high risk (G8) PCa. I am waiting to receive a response to my question as to how his treatment for my PCa squares with the standard for localized high risk non-metastatic PCa. Opinions from our more knowledgeable members would be appreciated.

[Tall_Allen]

So, the 18-month ADT SOC is not for your situation.

You received prostate radiation to debulk the original tumor in the hope of slowing progression. In your bone metastatic situation, the ADT SOC is life-long. It sounds like he is offering intermittent ADT to give you a break from ADT. However, a subset analysis of the Hussain trial suggests that continuous ADT may lead to longer survival than intermittent ADT when there is a low volume of metastases.

[6357axbz in reply to Tall_Allen]

Thanks TA.

Yet, my preference was longer term ADT cause I’ve responded extremely well and don’t feel any major QOL issues. He pushed for IADT. Keep in mind I am in his EXTEND trial (MDA) where I’m considered SOC, which apparently includes debulking via RT post Stampede, while the “extra care” group includes zapping individual oligometaststic mets.

After going on two weeks with no responese to my question I sent a follow-up to respond to my question. If I dont hear back I’ll try to find a way to communicate with a higher authority at MDA.

[Break60 in reply to 6357axbz]

Indeed you belong on continuous ADT. That’s why I switched to estradiol patches. See my profile.

[6357axbz in reply to Break60]

B60, I’m not sure what your profile tells me. Our cancers and disease histories are way different. Your initial dx was a curable cancer, mine was an aggressive G8 distant metastatic (bones) incurable cancer

[Break60 in reply to 6357axbz]

Yes but my initial dx was wrong except for Gleason score of 9 . After RP I was stage 3. I agree it took me awhile to get there compared to you but I got there quickly. Then I was stage 4. But I’ve beaten it back to undetectable with lots of tx. Keep on kicking it’s butt!

[6357axbz in reply to Tall_Allen]

Coincidentally my mo called me moments after I read your responseTA. His position, and I’m paraphrasing, is that there are no relevant presidents for my situation. As you said the phase 3 study was for a curable cancer, not my situation. My ADT included Abitoterone which changes the landscape. He said that for the localized cancer while 18 months may have been equally as effective as 24 or 36 months, 4, 8, 12 or 16 months, for all we know may be equally as effective, that has not been tested.

[6357axbz in reply to Tall_Allen]

And this is what my MO just messaged me:

The study you are on (EXTEND) treats patients with metastatic disease, so XRT + ADT is designed to improve control (with acceptable toxic effects) rather than to cure prostate cancer.

When we control rather than cure cancers, many treatments provide maximal therapeutic benefit or therapeutic ratio after about 6 months of treatments, such as when we give intermittent ADT after surgery or XRT for biochemical progression of disease, or when we give chemotherapy + ADT for patients with more advanced metastatic castration sensitive prostate cancer.

On the EXTEND trial, patients also receive abiraterone in addition to ADT + XRT. If there is synergy between abiraterone + ADT, then the old data using ADT >6 months may become out of date with forthcoming new data in the near future.

[Schwah]

You are saying two things that are very different. You say you have “distant ogliometastic bones” and you say you have “non metastatic PC”. It’s one or the other. Can’t be both. If you are interested ogliometastic, you should add Zytega ASAP and consider SBRT to the mets.

Schwah

[6357axbz in reply to Schwah]

Please re-read Schwah. I didn’t say I have non-metastatic PC.

[Hirsch in reply to 6357axbz]

In your opening you said your RO is controlling your ADT regimen. Is that really the case or a typo?

[6357axbz in reply to Hirsch]

Not controlling but suggesting to align with his clinical trial. My MO is on board.

[RonnyBaby]

I agree with T_A and the others who see ongoing ADT as the most likely route to go.

Perhaps an ADT holiday might be in order IF you respond well to treatment and the SEs / QOL aren't issues for you.

Here's wishing you the best ....

[tallguy2]

Why in the world would you stop ADT when you have confirmed metastatic disease? I'm sorry, fellow traveler; you, and I, will be on ADT for life. Think longer survival times. Read Tall_Allen's post. He's right.

[6357axbz in reply to tallguy2]

Mostly listening to my Drs. There seem to be quite a few here on IADT for many cycles. I have also heard that if you are going to do IADT do it prior to 24 months on for reasonably chance of T recovery.