"ADT prior to mets may not improve QoL or OS in BCR prostate cancer and may result in irreversible adverse events at high costs. Early use of novel androgen receptor targeting drugs (NARTD) prolonged MFS in nonmetastatic-castration resistant prostate cancer (nmCRPC). However, clinical details prior to castration resistance and explicit criteria for starting ADT were not given. We hypothesize that deferring ADT until mets results in outcomes comparable to those reported with early ADT, irrespective of NARTD used in nmCRPC."
Methods:
Retrospective review of men who underwent RP from1983 - 2014 within Johns Hopkins and the Center for Prostate Disease Research Multi-Center National Database, developed BCR and did not receive ADT until metastasis. Kaplan-Meier estimates of MFS and OS were defined from RP to event/last follow-up. Multivariable Cox proportional hazard models identified predictive factors.
Results
Table852P
PSADT
Overall < =6 months < =10 months
# developed M + 595 (20%) 198 (45%) 309 (38%)
Median MFS (all) not reached 12 (8-16) years 16 (15-21) years
Median MFS (M+ only) 6 (6-7) years 3 (3-4) years 4 (4-5) years
Median OS 21 (20-22) years 14 (12-17) years 17 (15-18) years
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Conclusions
Deferred ADT until time of metastases results in long MFS and OS even with short PSADT suggesting that it remains possible that prolongation of MFS in nmCRPC may not reflect true overall net therapeutic benefits which requires prospective study to define specific patient selection and criteria for initial ADT implementation, control of post progression management and QoL/OS information.
PSA increase with anxiety
18F-DCFPyL PSMA PET/CT Scan Result
