PSA Nadir After RT+ADT for Prostate Cancer Predicts Outcomes

[Scout4answers]

monthsrenalandurologynews.com/hom...

One could read this and construe that that 6 months of ADT would be as good as as 24-36

but of course it does not measure different co-morbidities nor gleason scores and other factors:

The 10-year prostate cancer-specific mortality rates for patients with a PSA nadir of 0.1 ng/mL or higher were 14%, 15%, and 14% for the patients who received RT alone, RT plus short-term ADT, and RT plus long-term ADT, respectively. The rates for patients with a PSA nadir less than 0.1 ng/mL were 8%, 7%, and 7%, respectively.

The 10-year overall survival rates were 58%, 56%, and 50% for patients with a PSA nadir of 0.1 ng/mL or higher, respectively, compared with 52%, 62%, and 63%, respectively, for those with a PSA nadir less than 0.1 ng/mL.

[maley2711]

Too much of a generalization without regard to other variables that are associated with .outcomes......primarily Gleason score....IMHO.

[Don_1213]

I read this paper yesterday and my impression was it draws conclusions with inadequate data and possibly outdated treatment data.

meetings.asco.org/abstracts...

That's the actual abstract of the paper. While it compares 3 different forms of treatment (RT alone, RT + Short-Term ADT, RT + Long-Term ADT) and groups these into two groups based on PSA at 6 months from the conclusion of treatment, it never discusses exactly what prompted the treatments used on the different patients. I would have to assume that the treatments were based on things that fall into the "risk" categories typically used for PCa diagnosis (Low risk, intermediate risk, high risk).

The paper doesn't include any indication that factors that may depress PCA readings (such as finasteride used for urine flow issues) were considered. I'm a very good example of that - my PSA for a full year after RT treatment was 0.1 or <0.1 (undetectable with the test used).

During that time I was on ADT and finasteride for continence issues. When I stopped taking the finasteride my PSA number doubled over a short period of time, and has remained around 0.23 (+/-0.04) for the past 2 years.

So taking my history - where would I have fallen in that study (RT + 18 months of ADT)?

The other factor that really is rarely taken into account is the difference in SOC between when the patients were treated (10 years before the study) and current practice.

And finally from the abstract "Table shows 5-yr MFS, 10-yr PCSS and 10-yr OS based on PSAn within 6m after RT completion." - uhhhh..

In this case, two of the groups that were categorized in the study quite likely were still on or affected by ADT - which is known to depress PSA. When I first read the reports on this paper - this wasn't at all clear -- when the 6 months started. I had assumed it meant 6 months after concluding ALL treatment - especially ADT. Nope. IMHO - thats a big flaw in the study.

I have to agree with maley2711 - a much too generalized study based on inadequate and out of date information. But - that's just me.

[Scout4answers in reply to Don_1213]

I agree it is flawed.

[PSAed in reply to Don_1213]

Thanks for posting that.

I was on LUPRON for 2 years ( now completed ) but was /still am on DUODART... (Tamsulosin/Dutasteride) while on LUPRON. My PSA tests have been undetectable throughout treatment and my last PSA test 6 months after finishing treatment was also <0.01.

How can my PSA tests be of use to my Oncologist if the results are skewed by DUODART? He prescribed it.

[Mgtd]

sometimes the trouble with article summaries is that you lack the actual analysis. You may want to look at the real thing.

meetings.asco.org/abstracts...

[Hidden]

I have seen another study like this and had the same issue with the timing of ADT. But it seems like the study is just saying something simple. That <.1 PSA 6 months after RT is better. Even with ADT. Because a significant number don’t have PSA <.1 at that juncture. We may be trying to dissect it more than we should. There is another study that talks about the difference between 6 months ADT and 18 months.

[Spyder54]

I’m quite certain I remember TA saying that Finesteride /Dutesteride have less effect on PSA over time. Yes, upfront they talk about doubling PSA if on the “rides”, but not long term. What is long term? Longer than 1yr? 2yrs??

Maybe TA can jump in if he remembers that previous discussion. Mike

[CAMPSOUPS in reply to Spyder54]

Not all encompassing but a little info. on Finasteride:

healthunlocked.com/advanced...