Duration of ADT needed with salvage radiation

[Tall_Allen]

6 months? 24 months? New data from the "Formula 509" trial shows that hormone intensification with adjuvant apalutamide+abiraterone+ADT for just 6 months with salvage radiation therapy (SRT) may be all that's needed:

prostatecancer.news/2023/02...

[Papillon2]

No shit! Thanks Big Guy. You know this is what I been waiting for. You da man!

[cesanon in reply to Papillon2]

I think TA's article is a bit more nuanced than that.

[j-o-h-n in reply to Papillon2]

Man, you is right.... T.A. is not only da man, but he's a cool cat and da pillar of the community...

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 02/19/2023 7:46 PM EST

[Papillon2 in reply to j-o-h-n]

Thnx you. My friend.

[garyjp9]

Thank you, TA

[Cyclingrealtor]

So with my surgery pathology (9/21) PSA 16.2/ svi/ pni/ epe / G4+3/ tertiary 5 / 36 ln clear

April 22 - BCR .1 to .4 in 7 weeks. PSMA pet with 1 deep right obturator lymph node.

July/ Aug 22 - 33 rounds of EBRT and Lupron

1/23 added abiraterone to the mix.

Sounds like I'm still on the right track!?!?!?!!

Yeah?

I know 6 months of adt had my labs barely creeping out of the healthy "range". 53 years of good of great health took a punch right between the eyes! Hoping 18 more months will knock the PCa into ned!!!

[OzzieJ]

Thank you TA for that really useful summary 👍

[ragnar2020]

TA, Very interesting summary sending me out to read the underlying stuff. Thanks for doing the yeoman’s work. I wonder how my next MO conference will go with my MO after their recent conference and the various findings they will have bullshitted about over cocktails? Hope your own numbers are stable and sleeping quietly so you can relax too.

[PJ95]

As I am currently undergoing SRT + ADT , so thankful to have Dr Nguyen as my RO as we discussed these trade offs as part of my planning. DFCI rocks!

[Tall_Allen in reply to PJ95]

He is one of the best!

[fishrocky in reply to PJ95]

Had my last of 40 SRT with Dr. Nguyen in November...he is one of the best!

[Trying-Times]

Good Info.

[gsun]

Thanks for this. My brother had RP and now his PSA is going up. He is going to get radiation and this may relate to his treatment.

[dans_journey]

Thanks for sharing, TA.

I have to wonder about the timing of the start of concurrent ADT and its impact on the results, though.

Doing a quick scan of the 0-6 month studies you provided in your link, two of the four studies started ADT at the start of SRT; one started ADT 2 months in advance of SRT; and I couldn't find any details in the 4th.

For me, it's water over the dam, as my RO had me take a 6-month dose of Eligard 2 months before the start of SRT. His logic—right or wrong?—was that the ADT needed time to weaken the cancer cells before starting SRT.

Just food for thought...

[Tall_Allen in reply to dans_journey]

Starting ADT 2 months before SRT is typical, from what I've seen. But a recent analysis by Amar Kishan questioned whether any "neoadjuvant (before radiation)" ADT is needed at all. He found that with primary (not salvage) radiation therapy, it was only the concurrent (during) and adjuvant (after) ADT that made a difference. But his analysis only included men treated on a couple of clinical trials with primary radiation that was delivered over 8 weeks. Maybe the 8 weeks of concurrent ADT is enough "pre-loading" for salvage too?

[tallguy2]

thank you!

[TEBozo]

18 months of Lupron plus Zytiga and Prednisone for the last 12 months. SBRT at beginning of Zytiga.

[Grandpa4 in reply to TEBozo]

me too! And going.

[TEBozo in reply to Grandpa4]

Hope you are well!

[Grandpa4 in reply to TEBozo]

I got sacral fractures from radiation but otherwise doing we. I exercise and lift weights so I have been able to mostly maintain my strength. PSA is zero which is always good.

[Mikeski]

Thanks TA.

I participated in this trial. 3 years undetectable and praying it stays that way!

[maggiedrum]

Per the paper cited: "6 months of ADT with apalutamide and abiraterone. - The Formula 509 trial found that intensifying ADT with both apalutamide (Erleada) and abiraterone (Zytiga) compared to bicalutamide 50 mg/day, MFS improved by 43% and PSA-free survival improved by 29% with 34 months of follow-up. Among post-op patients with PSA>0.5, MFS improved by 68%."

The finding was that the increase in MFS was in comparison to the addition of bicalutimide along with SRT, not to SRT alone.

[Tall_Allen in reply to maggiedrum]

That's what the article says.

[Grandpa4]

I have been on abiraterone and ADT for 15 months. How much longer should I go?

[Tall_Allen in reply to Grandpa4]

I have no idea what your situation is - there's nothing in your profile.

[Grandpa4 in reply to Tall_Allen]

wow. I had filled that out previously. Will try to fix that.

[Tall_Allen in reply to Grandpa4]

Thanks, I see it now. Are those PSAs correct? So you never had any positive lymph nodes detected on your PSMA PET/CT? If that is the case, I don't understand why you are getting abiraterone at all and such a long course of ADT? Was it because of what later turned out to be false positives?

[Grandpa4 in reply to Tall_Allen]

No not all the PSAs were right. 0.02 was 0.2. I think my MO is very worried about my histology and I think they are not 100% sure the rib is an artifact. . Also you can’t really trust my PSA because I never had an elevated PSA. I understand there is data to suggest higher cure rates with longer therapy and adding abiraterone. I am starting to wonder if it is worth it because of the side effects. Maybe I could at least stop abiraterone and prednisone. I really don’t mind ADT. No fatigue and with weight lifting I have not lost muscle.

[Electrician in reply to Grandpa4]

I have been on Abiraterone ADT and prednisone for over 5 years and PSA is stable at 0.01. As I have few side effects my Oncologist doesn’t want me to change meds or contact me for six months. I have blood tests every two months which are fine. The only downside is I have to self fund which is very expensive as the NHS won’t fund Abiraterone.

[Grandpa4]

ok it is done. Sorry!

[TylexGP in reply to Grandpa4]

Unfortunately nothing is showing in your bio still. Once you have edited your profile and added what you want make sure to click on view my profile it appears to work as a save button.

[Grandpa4 in reply to TylexGP]

it keeps deleting it. Very frustrating.

[Grandpa4 in reply to TylexGP]

ok I think I got it this time.

[TylexGP in reply to Grandpa4]

Yep, I can see it now we have some similarities and differences. Good to see you have done pretty well given the G8 and the Intraductal histology. Did you have genetic testing done as a DDR (e.g. BRCA2) mutation might make PARP inhibitors an option.

[Grandpa4 in reply to TylexGP]

Yes no know mutation except for a previously unreported mutation in HOXB13. My brother has same mutation. I will add to bio

[Grandpa4]

it begs the question. How good would people do if they got all three drugs for 2 years.

[roman44]

ttps://youtube.com/watch?v=cyY0nHX...(Not working as expected?)

ADT and Radiation vs. radiation only study. ADT added very little to survival.

[Tall_Allen in reply to roman44]

This thread is about salvage radiation, not intermediate risk.