Useful guidance on who may or may not benefit from ADT after RP stratified by post-surgical PSA levels.
From RTOG 9601 "PSA Levels After Prostatectomy but Before Salvage Radiotherapy Associated With Outcomes of Long-Term Antiandrogen Therapy"
jamanetwork.com/journals/ja...
TAKE-HOME MESSAGE (From PracticeUpdate)
"The authors of this secondary analysis evaluated the association between PSA levels before salvage radiotherapy and the benefit of adding long-term antiandrogen treatment to salvage radiotherapy in 760 men with PSA elevation after radical prostatectomy. Antiandrogen therapy was associated with superior overall survival in the group with PSA >1.5 ng/mL (HR, 0.45), with an absolute 12-year benefit of 25%. No benefit was observed among those with PSA ≤1.5 ng/mL. However, there was an improvement in overall survival seen in a subanalysis of men with PSA 0.61 to 1.5 ng/mL (HR, 0.61). Men with a PSA <0.6 ng/mL had no overall survival improvement but did show an increased risk of high-grade cardiac and neurologic toxicity with antiandrogen therapy.
These findings highlight both the potential benefits and harms of antiandrogen therapy and suggest that pre–salvage radiotherapy PSA levels can be used to personalize the treatment decision."