L/T vs S/T ADT post SRT & WPLNs?

[jjpeabody]

I just finished SRT & WPLN's and feel much better than I imagined (although going to dentist today about some small persistent sores on my gums that showed up last couple weeks of therapy and are slow to heal) . I've been on ADT for 16 months and last shot will expire in 2 months. PSA has been consistently <.01 and testosterone below 20. PSMA PET on 2/2021 showed 0.8 cm tumor in surgical bed (boost to bed), GS 4+3=7, Decipher. 056, age 72 . RO seems to think pre ADT of 16 months with 2 months post, and low volume disease on PET scan with intermediate Decipher suggests that is enough hormone therapy. I see MO Monday. Any recommendations on length of ADT post SRT very much appreciated, thank you.

[tango65]

In the RCT SPPORT trial (radiation to the prostate bed plus pelvic lymph nodes) they used 4 to 6 months of ADT and they obtained a 87.5% progression free survival at 5 years .

thelancet.com/journals/lanc...

astro.org/ASTRO/media/ASTRO...

[jjpeabody in reply to tango65]

Thank you tango65, most of the ROs I've consulted with leading into the treatment are recommending a short course post ADT. I was thinking of adding 6 months of Zytiga and casodex without any further Eligard just to make sure, but after what will be 18 months of ADT mostly pre SRT I am ready to go with no further ADT post treatment. I did take a short 2 month holiday after 2nd 6 mth shot and PSA remained <.01 so expecting ADT effect to continue for some time. Pretty much the only problem I had with treatment was urgency which was manageable with a penis clamp and no longer needed. Moderate burning to surgical bed and urethra now but all manageable. Dentist said sores on gum were not cancer but probably fatigue and stress I've been thru. A bidet squeeze bottle came in handy and works so well I will continue to use regularly. Thank you again.

[tango65 in reply to jjpeabody]

If you did not have any evidence of cancer in the pelvic lymph nodes a shot term ADT around 6 months plus the radiation to the PB and lymph nodes seems to be adequate. If there had been pelvic lymph nodes mets (N1) then the recommendation are 2 years ADT plus abiraterone.

[Tall_Allen]

Just to be clear, you treated the pelvic lymph nodes because of the high risk, but none of the scans you've had revealed any cancerous lymph nodes, right?

The SPPORT trial found that 4-6 months of adjuvant ADT (starting 2 months before SRT) had good results:

prostatecancer.news/2022/05...

The GETUG-AFU-16 trial added 6 months, starting the first day of SRT:

prostatecancer.news/2016/08...

[jjpeabody]

Yes Tall_Allen, only tumor to surgical bed. My last 6mth shot will last for another 2 months. Plus when I took a 2 mth holiday after 2nd shot PSA remained <.01, so I expect at 72 i will remain below .10 for sometime and monitor every 3 months. I was going to take additional 6mths Zytiga and casodex while stopping Eligard but RO felt unnecessary but he did say run it by my MO monday. P.S. Long live Dr. Sandler! Thank you.