Here is a link to a recent and fairly comprehensive multi-section set of articles on the use of neoadjuvant (i.e., treatment begun before the main treatment and continued alongside the main treatment) ADT. The articles are mainly about ADT and surgery, but also contain a small amount of information about radiation and neoadjuvant treatment with other drugs including chemotherapy, Provenge, and others.
The articles struck me as aiming to be scientifically accurate, but not highly technical. You don't need to know a lot about statistics, anatomy, or biochemistry to understand them.
You may have to join Medscape to read them but membership is free.
Alan
Written by
AlanMeyer
To view profiles and participate in discussions please or .
Neoadjuvant hormone therapy with surgery has drawbacks. It impairs the basis for taking a position on postoperative radiotherapy by affecting the PSA value as well as the histological assessment of extraprostatic extension, surgical margins and lymph node metastasis.
Yes. This is discussed in the sixth section of the article "Histopathologic Changes in NADT". Apparently some surgeons are thinking that's not as much of a problem as it was once thought to be. I was surprised to see that.
To me, the biggest question is, Will ADT improve the outcomes of surgery for at least some identifiable patients? I haven't seen clear evidence that it will - though I've read only a tiny fraction of the literature on this. If we don't get evidence that it improves outcomes, then I think your objection to it is important and adds to the objections that patients have to the side effects of ADT Obviously a placebo controlled trial isn't possible. All the patients and doctors will know when a patient has been given ADT. But a randomized control is possible.
As a participant in Neoadjuvant clinical trial study NCT02849990, I found this article informative. Thank you for sharing, as I found it very much informative. From personal experience, neoadjuvant HT & ADT has been beneficial to my recovery.
I plan to update my bio here next June. I will do this once I get my next PSA test. You see next June will mark 3 years post RP, where every PSA reading since has been below a (<0.03) threshold. I feel so very grateful to have participated in this clinical trial, and I do sincerely believe it has extended (if not saved) my life.
I wish everyone best of health! Stay strong, live each Day.
Thanks for this. I also participated in a trial and feel it was beneficial. Started as Gleason 9 and after surgery had complete response (no cancer seen). My trial at NIH was 6 months of “intensive” ADT before surgery.
I am not surprised that the article says most trials are 3 months of regular ADT and these were inconclusive. That’s probably not enough to make a difference.
What I am curious to know if anyone has started to monitor longer term info on intensive neoadjuvant adt followed by surgery. Results I have seen reported only go for the first 4 years.
I had 6 months of Lupron, Abiraterone and Apalutimide prior to RP in January 2019. My PSA stayed at .03 until July of 2020 when it hit .05. The PSA hit .1 a couple of months ago, and now I’m having RT. I was Gleason 9 before treatment. I had SVI post surgery.
I read a study once that said the odds of success for salvage radiotherapy were best if done while the PSA is still below 0.4. Your PSA is likely to still be well below that before your RT starts.
Most definitely QOL issues must be considered with the use of ADT, of course.
Also, I would caution that until real benefit is established, to consider it's use wisely. Only because if recurrence is experienced, the prior use of ADT may preclude a patient from participating in certain trials down the line. Access to trials affords many patients benefits to the newest, and bestest treatment modalities... Especially for advanced or high risk patients that know there will be serious consideration to the use of lines of treatment and the staging of using them.
All that said, it's interesting to see some treatment modalities used earlier and earlier, some with good effect!
Content on HealthUnlocked does not replace the relationship between you and doctors or other healthcare professionals nor the advice you receive from them.
Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked.
PTEN loss is not a determinant of time to castration-resistance following androgen-deprivation therapy in prostate cancer
Impact of Androgen-Deprivation Therapy on Self-Reported Cognitive Function in Men With Prostate Cancer
Prostate Cancer Therapy:
