"Who should not get ADT? Anybody else with prostate cancer. If you just have a rising PSA after radiation therapy or radical prostatectomy, that is not a good enough reason for a doctor to put you on ADT. If your doctor wants to put you on ADT to “shrink your prostate” before brachytherapy, that’s not a good enough reason."
"ADT has never been shown to extend life if it’s given too soon."
"Why not just give it? At least it’s doing something, rather than sitting around waiting for the cancer to spread. Well, that sounds good. Please refer to the previous paragraph, and read the last sentence again. Now, if you have a rising PSA, there are other things you can do that may help a lot......."
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George71
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That is what the science says --- No ADT unless mets. even with PSADT of less than 6 months
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.
"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."
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.
I don't know ... but at the bottom of many of the trial papers they list the abrv.
I'm sure you know many of the most common --- Your PSA number --prostate cancer specific antigen -- cells give off PSA in the blood and is just a number that helps tract prostate cancer growth or doubling time... PCa stands for Prostate cancer mPCa is for metastatic prostate cancer nmPCa is non - metastatic --- CRPC stands for castrate resistant prostate cancer --- nmCRPC is non metastatic --- mCRPC is for metastatic
Most articles will spell out the term the first time it appears in the article and then right after it they will in parenthesis give the abbreviation ...everytime after that they just abrv. it to save space and time.
like .. Prostate Specific Antigen (PSA) so if you see an abrv. in an article -- look back above and find its first occurrence it should spell it out.
MFS -- is metastasis free survival ---- OS is overall survival --- ADT is androgen deprivation therapy
The idiosyncratic nature of Prostate disease is such that no one, two, or three sizes fits all.
The author states that it is beneficial for high-risk guys who are going to do RT. And also beneficial for guys with mets (does this include micro-mets?)Probably be beneficial for me at some point. Might be sooner rather than later or perhaps already here.
But I am going to continue BAT, regardless of this article. I've found ways to get around the bone loss, cardiac issues, hot flashes, muscle loss, and depression from ADT so it is no longer out of the realm of possibility for me (probably got around libido and man-boobs too - I certainly have some libido during the low T phase of BAT but don't know how it would play out over years). In fact, I'm planning on some ADT and BAT before/during/after radiation (if BAT fails and Xtandi or another "mide" won't work I will probably scurry away to RT).
As others stated, we are all so unique that a one-size-fits-all approach isn't going to work. That said I think that doctors are sometimes too fast to recommend ADT. It isn't always called for but almost every doctor I have talked to seems to think that ADT is automatically the way to go. My MO is an exception. She wanted me to do a half year of ADT after RP but she doesn't think that I should ever do it again outside of specific scenarios.
RSH1 wrote --- " ... As others stated, we are all so unique that a one-size-fits-all approach isn't going to work... "
"We are each an experiment of one. A unique, never -to-be repeated event" by Dr. George Sheehan --- see below
" ... Dr. Sheehan was diagnosed with prostate cancer in 1986. By the time it was discovered it had spread to his bones. For seven years he lived with the cancer, and “made every day count... "
" ... he ran a 4:47 mile, which was the world”s first sub-five-minute time by a 50-year-old... "
" ... George Sheehan died four days short of his 75th birthday on November 1, 1993... "
“Don”t be concerned if running or exercise will add years to your life, be concerned with adding life to your years.” Exactly. I want more good years, not just more years.
The heterogeneous nature of the disease prescribe that everyone is different, our PCa is different. The defining factor could very well be the accuracy of diagnosis and appropriate therapy applied! The lumping of patients conveniently into subgroups in SOC for therapy are counterintuitive to individual care. The trick is to get a care team that looks at "YOU" for you, and not as a group. The issue then is that the "group" provides some answers as to guesswork as to what might work best for "your" diagnosis and prognosis. Contemporary medicine doesn't really provide the individual care we would all want. And for patients who fall far outside the "norm" of these convenient diagnostic subgroups, we suffer from this paradigm to a greater degree. We have yet to even diagnose if patients actually HAVE those PCa cell types studied in some of those trials. Again, patients get lumped together, regardless... We are getting close, bit individual care really isn't the norm.
Noted above, the BRCA Gene mutation or deletion survivability... Yes, statistical data support it. And there are drugs available for this condition, unfortunately, because of FDA rules, they're only (currently) available to patients who have failed other treatment lines and become more advanced further down the line of progression. Does this make sense when it's an statistical association, not necessarily a "causation"... But yet, even if a patient has this upon initial or early diagnosis, it's a treatment reserved...
So... I remember reading a long time ago, how these statistical numbers lie. Not that they're wrong in themselves. But that we are not necessarily falling within the circle that a study may apply to.
Just thoughts, not asserting any other claim of what works or doesn't or what should or shouldn't...
Great post. I totally agree. It’s so important to be your own advocate and be armed with as much knowledge as possible to create a team that treats you and not just the disease.
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