Men with Radiation Therapy to Pelvic Lymph Nodes + ADT had 90% 5 year better outcomes. Phase 3 Trial posted in the Lancet. Cedars Sanai.

[Spyder54]

This from Male Care Prostate News.

cedars-sinai.org/newsroom/n...

[MateoBeach]

Another “brick in the wall” of the SOC. Too bad they couldn’t also test SRT to prostate bed plus full pelvic RT without ADT.

[Spyder54 in reply to MateoBeach]

Yes Paul, agreed. We all wish we could use a lot less ADT.Hard to find studies without ADT. My point in posting this was in its simplest form, you can see better 5 year numbers by adding pelvic lymph node RT to the combo. Yes, it is a varied group, but this is a Phase 3 study.

“Group one received salvage prostate bed radiotherapy—a standard radiation targeted to the area in which the prostate used to exist before its surgical removal. These patients had a median five-year survival of 71%.

The second group received the standard radiation treatment, in combination with androgen deprivation therapy. They had a median five-year survival of 81%.

The third group received salvage prostate bed radiotherapy, androgen deprivation therapy and pelvic lymph node radiation. These patients had a five-year freedom from progression of just over 87%.”

Mike

[Justfor_]

Not convincing at all. They don't explicitly state that the 3 cohorts were matched for PSA, PSADT before the start of sRT, nor risk stratification. These three parameters have been found in previous studies to affect the time to recurrence.

They write and I quote:

"Eligible patients (aged ≥18 years) were those who after prostatectomy for adenocarcinoma of the prostate had a persistently detectable or an initially undetectable and rising PSA of between 0·1 and 2·0 ng/mL"

See how the PSADT parameter affects progression:

"Prediction of survival outcomes following postoperative radiotherapy after radical prostatectomy for prostate cancer" (2019)

tandfonline.com/doi/full/10...

PSADT

[Justfor_ in reply to Justfor_]

See now the influence of the pre-sRT PSA (same source as above)

PSA

[Justfor_ in reply to Justfor_]

They write and I quote:

"... Other eligibility criteria included pT2 or pT3 disease, prostatectomy Gleason score of 9 or less..."

It can be anything from low, intermediate up to high risk.

Finally, the risk stratification influence from:

"Salvage radiotherapy for biochemical recurrence after radical prostatectomy:

does the outcome depend on the prostate cancer characteristics?" (2019)

ncbi.nlm.nih.gov/pmc/articl...

With a different mix of just these three parameters, some also engage the GS into the mix, they can prove anything they would like.

Risk stratification influence to time of reccurrence

[Spyder54 in reply to Justfor_]

Justfor,Phase 3 study. Wont get much better than this with clear 5 yr advantages. There are so many combos of Men we could use here. I would like to see a less powerful ADT, for example like Bicalutamide. Now we know Abi has a 1.77% risk of cardio events. Nal talks about mixing it up so that PCa cannot figure a work around. All this makes sense. But the clear 5 year advantages are clear here despite the mix of Men.

“Group one received salvage prostate bed radiotherapy—a standard radiation targeted to the area in which the prostate used to exist before its surgical removal. These patients had a median five-year survival of 71%.

The second group received the standard radiation treatment, in combination with androgen deprivation therapy. They had a median five-year survival of 81%.

The third group received salvage prostate bed radiotherapy, androgen deprivation therapy and pelvic lymph node radiation. These patients had a five-year freedom from progression of just over 87%.”

Best, Mike

[Justfor_ in reply to Spyder54]

Sorry Mike but you are not an observant reader. If you were, you would had noticed that the lousy journalist that wrote the article made a salad by mixing up survival as the endpoint for the first 2 groups with freedom from progression for the third. The published paper compares the latter for all 3 groups and not apples to oranges.