Thoughts? ADT following RT if PSA is already low (0 to 0.6)

astro.org/News-and-Publicat...

[Teufelshunde]

When I had BCR, my RO at U Chicago said he was indifferent as to whether I took ADT. Just looked at ADT as a radiosensitizer. Got second opinions from MOs at Northwestern and Dr Morgans said no need to do that and another MO said do for 6 months. I took oral for 1 month prior to SRT and stopped. Glad I did. PSA was 0.32 and after ADT was 0.06 day before I started SRT. Plenty of other radiosensitizers out there without side affects of ADT.

[Hidden in reply to Teufelshunde]

Thanks. What do you think the radiosensitizers include? My MO thinks statins, fasting and possibly metformin.

[Teufelshunde in reply to Hidden]

Curcumin, melatonin and fenbendazole(?) should be considered, in addition to statin. See the below.

ncbi.nlm.nih.gov/labs/pmc/a...

pharmamirror.com/common-pha...

ncbi.nlm.nih.gov/labs/pmc/a...

[Justfor_]

They revisited the earlier data after the presentation of 3 studies and a meta analysis presented in Spain 2019. With the newer stratification conclusions aligned.

[Tall_Allen]

Who is trying to get you to take ADT with salvage RT with PSA that low? I don't know anyone giving ADT with SRT for a non-LN recurrence when post-prostatectomy PSA <0.6.

[j-o-h-n]

Buy more eggs when you're down 1/2 dozen (out of a dozen)?

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 02/27/2022 6:54 PM EST

[Shooter1]

I didn't have such a hard decision after prostatectomy. PSA jumped 10pts to 63, right to ADT and Chemo. Starting into year 5 with new BCA for radiologist to zap.

[Tall_Allen]

I'm amazed that it still goes on. When I run into cases like that, I ask the patient to email the following to his doctor.

redjournal.org/article/S036...

ROs will usually pay attention to a peer-reviewed journal article (especially from the "Red Book") and especially with a name like Dan Spratt attached to it.

[Blackpatch]

You need to read Dan Spratt's paper carefully - his position is far from black and white in situations where there is particularly negative pathology (pT3b and above, or M1), or negative genetics. As he says in his second from last para, in these settings, ADT may be advisable even at low PSA.

I had eSRT at PSA=0.117 and actually corresponded with Dan in 2019 when he was fairly visible on this topic - his view was that the 8 months of zytiga alongside 12 months of conventional ADT was a very sensible approach given my Decipher score of 0.91.

So... make sure you have thought about your pathology and genetics before making a final decision.

Stuart

[Hidden in reply to Blackpatch]

Thanks Stuart.

I'll look into it and of course talk to my MO and RO before deciding. As of last month I didn't have any genetic mutations. And my PSA is undetectable. Plus I hate ADT. Still, if it is part of BAT or modified it's pallitable.

In other words, I'd love to find an excuse to avoid ADT 😏

Russ

[Blackpatch in reply to Hidden]

It's RNA sampling of the actual tumour that's required, rather than normal "germline" DNA testing - but not cheap, even in the US where it's done.

[Hidden in reply to Blackpatch]

Not somatic then? I had one germline and a few somatic tests done. Nothing found on any. Is there some RCT info or a URL you could point me to?

[Blackpatch in reply to Hidden]

Hi - Decipher is based in the west coast, I think. The cost for an international patient about three years ago was about US$3k, I think.

decipherbio.com/

If you hunt around on their site you can find papers demonstrating the correlation between Decipher and a range of PCa outcomes … you need to look for the test related to RO specimens as opposed to testing of cores from biopsies….

[Hidden in reply to Blackpatch]

Thanks. I had Guardant. I was undecided between Decipher and Guardant but my MO likes Guardant and talked me into it based on the use of it in some of her clients (specifically, they developed AR7 mutations and responded to targeted therapies).

I'll look at Decipher again to see if it has any coverage I missed.