Short-term androgen annihilation in non-metastatic recurrent men delays progression

[Tall_Allen]

If one has rapid PSA after salvage radiation, and no metastases on conventional imaging yet, there may be an advantage to adding short-term (8 months-1 year) therapy with a 2nd line hormonal agent (Zytiga, Xtandi or Erleada):

prostatecancer.news/2022/09...

[Papillon2]

Thnx. TA. Good to know for future reference. My son is undergoing SRT with ADT at the present time.

[Tall_Allen in reply to Papillon2]

Hopefully, he'll be cured by that.

[Papillon2 in reply to Tall_Allen]

If not, this will become Plan C.

[Jmr11820]

I was advised two years ago to forego ADT. My situation was a high risk Decipher, positive margin, and very low PSA (.03) at the time I started adjuvant RT. Studies at that time showed that ADT could be more detrimental than beneficial for low PSA patients. So far, so good for me, but what is the current post prostatectomy guidance being offered to guys with adverse pathology and high risk decipher whose PSA has just started to creep up? Has it changed?

[Tall_Allen in reply to Jmr11820]

This is not for adjuvant hormone therapy (with radiation), as you already had. It is for early salvage hormone therapy if salvage radiation fails. Median PSA at the time of salvage radiation failure was 0.5.

[Jmr11820]

I understand. I was simply asking if RTOG9601 was still the guiding light, to any extent for ESRT or SRT with low PSA. If my RT should fail at some point, sounds like this new work you’re citing may apply. As always, thanks Allen, I appreciate what you do.

[Tall_Allen in reply to Jmr11820]

RTOG 9601, GETUG-AFU-16, NRG/RTOG 0534, and RADICAL HD all address the question of ADT duration.

[podsart]

Still not getting your news letter. Strangely when I just entered my email to subscribe it gives error message that I am already subscribed

[Tall_Allen in reply to podsart]

And you checked your spam folder? Sorry, I don't know how to fix it.

[podsart in reply to Tall_Allen]

yes did, thanks for trying

[Teufelshunde]

Just making sure I understand this. The 21 month follow up was after the end of the one year treatment period?

[Tall_Allen in reply to Teufelshunde]

yes

[Teufelshunde in reply to Tall_Allen]

Ok. Is this the preferred next step after PR and SRT if PSA starts rising? One year of enduring ADT for two more years after that of relief. The other study you cite using abiraterone looks more like a 3:1 benefit, where apalutamide is only about a 2:1 benefit.

Are side effects much different between these two? Last, since the follow up was done at 21 months after stopping ADT, how do they know Group C was 26 mo. until BCR after stopping?

[Tall_Allen in reply to Teufelshunde]

You can't compare across trials - different patients. But the bRFS were identical anyway: 25 months for apalutamide and 27 months for abiraterone (not significantly different). Apalutamide wasn't tested for 8 months, it was only tested for 1 year.

Side effect profiles are similar, but they've never been directly compared.

Median follow-up was 21 months. bRFS is determined from the Kaplan-Meier curve. Longer-term follow-up is planned.

[garyjp9]

Thank you, Allen

[savanna1A]

TA, always good advise. Thank you