ADT or Brachytherapy Boost - plus External Beam Radiotherapy for Localized PCa.

[pjoshea13]

New meta-analysis below [1] [2].

I remember a significant study where brachy boost reduced PCa mortality but not overall mortality, so I would be wary of it. However, some feel that reducing PCa death is worthwhile even if it does increase the risk of death from other causes.

"In men with localized prostate cancer, the addition of androgen-deprivation therapy (ADT) or a brachytherapy boost (BT) to external beam radiotherapy (EBRT) have been shown to improve various oncologic end points. Practice patterns indicate that those who receive BT are significantly less likely to receive ADT, and thus we sought to perform a network meta-analysis to compare the predicted outcomes of a randomized trial of EBRT plus ADT versus EBRT plus BT."

"The results showed that adding ADT to EBRT significantly improved OS {overall survival} versus EBRT alone (hazard ratio [HR] 0.70 ...). Separate analyses of trials that enrolled mostly men with high-risk disease versus those with intermediate-risk disease yielded similar results (HR 0.66 ... for high risk; HR 0.73 ... for intermediate risk).

"In contrast, the addition of BT to EBRT (with or without ADT) did not improve OS "

-Patrick

[1] ascopubs.org/doi/abs/10.120...

[2] medpagetoday.org/hematology...

[cesces]

Hmmm very interesting.

Certainly non-intuitive to me.

I wonder where the increased mortality comes from?

[pjoshea13 in reply to cesces]

When diagnosed, patients aren't really thinking long-term. With surgery, one is stuck with the consequences - but that's it. With radiation, who knows? The immune system takes a hit The risk of local seconary cancer goes up a bit. Dr. Myers once described radiation as the therapy that keeps on giving. & more doesn't come without its downside. IMO

-Patrick

[Hidden]

I'm in the "some feel that reducing PCa death is worthwhile even if it does increase the risk of death from other causes" camp. Reason being is that I would like to take ADT off the table and also bone pain. Much rather die of a heart attack or a stroke and live life normally in the meantime. I'd love lifespan but healthspan is my second choice.

Increase in secondary cancer risk is pretty small to my understanding. Around 0.2%.

[pjoshea13 in reply to Hidden]

I don't know where the increased risk shows up. Secondary cancer risk doesn't appear in the first 5 years, Maybe the major risk increase is cardiovascular. A massive heart attack is probably preferred by many. Perhaps I should post a heart attack diet. LOL

I'd hate to have the kind of stroke that an uncle had. To be alive on the inside but a chronic burden otherwise. (Not that his wife views it that way.)

My approach, unfortunately reduces the risk of competing mortality. I fully expect to have PCa on my death certificate - so far down the road that I won't be around to read it!

Best, -Patrick

[timotur]

I've seen other studies that show treating the primary tumor with BT increases survival at the 10yr mark. I'm not sure I put too much stock into these meta-analysis studies that pick data from different studies with different populations. For example, one study using BT may have a majority of high-risk G > 8 patients, while a study using EBRT may have more patients G < 7.

[Hidden]

I'll post the heart attack diet.

Standard American Diet (SAD). Cookies, ice cream, cake, big gulps, fast food, processed food. Make sure to get no more than 3 servings of veggies a day and make sure that the servings are primarily from french fries, potato chips, and ketchup (with lots of sugar in it). Party on!

[tsim]

Not sure how they concluded that BT patients are less likely to receive ADT but at top cancer centers I've researched that is included in standard treatment course.