Overall survival (OS) & (MFS) in men with biochemical relapse (BCR) after radical prostatectomy / defer ADT treatment til metastatic

[George71]

"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

Open table in a new tab

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.

annalsofoncology.org/articl...

[Shooter1]

Interesting to see those guys living so long... BUT, when you start with mets in lymph nodes and bones and rising PSA after RP, you need to jump in and attack it... At least that was the advice of my urologist, MO and RO. Still here at 5 year mark so they must not have been to far off in their advice... Life Is Good, especially more and more abundantly...

[George71 in reply to Shooter1]

You are doing the right thing -- and it looks like it is working great. The BCR protocol wasn't for you.

[maley2711 in reply to Shooter1]

that doesn't seem to contradict the study...you had metastasis, so start ADT!!

[maley2711]

yet we do ADT for radiation + ADT for intermediate /high risk PCa men without metastasis?

[George71 in reply to maley2711]

Yes, -- it doesn't make since --- that was what kept me from doing radiation ..... In 2016 I tried for 3 months to get a Dr. to give me radiation WITHOUT ADT but none would -- so I did surgery -- my Dad and 2 uncles had radiation 25 + years prior without ADT and were cured. The R/O I wanted to use insisted I agree to 24 months of ADT.

[j-o-h-n]

Hello George. I was blessed already with overall survival when my crazy ex-wife left me.........

Hallelujah, Hallelujah. In the almighty words of Martin Luther King "free at last, free at last thank God Almighty, I am free at last!"

Good Luck, Good Health and Good Humor.

j-o-h-n Friday 04/01/2022 6:00 PM DST

[George71 in reply to j-o-h-n]

LOL !