Simultaneous vs Sequential Rad and ADT

[ElRanchoDePoisonIvy]

I'm trying to find out whether or not simultaneous rad and ADT is efficacious. Most people seem to feel that there is a synergistic effect to having rad and ADT at the same time, but I can't seem to find the mechanism for how that synergy occurs.

I have a hunch that it doesn't really exist, or if it does, that it's minor. It could be that the synergy seen is only apparent; that it's a statistical artifact caused by the 30% of the men who get short term ADT never getting their TET back. Meaning, the 30% of men who get short term ADT are, in effect, actually getting long term ADT because their TET never recovers. So that study cohort gets a cure benefit when it really shouldn't. Those 30% should be weeded out of the study results, and maybe they are, but I haven't been able to find out much on that.

The proper thing to do would be to compare simultaneous rad + ADT with sequential rad *then* ADT and then look at the 5 and 10 year OAS and Met numbers for both cohorts. Maybe those studies exist, but I haven't seen any.

Anyone have any info on this?

[Magnus1964]

Your PSA is still very low. Why are you having radiation? You're still young. I would avoid radiation as long as possible. The long term side effects of radiation are not pleasant.

[ElRanchoDePoisonIvy in reply to Magnus1964]

I’ll probably be at 0.2 by November, give or take a month or two. Most of the ROs I’ve seen say that’s the treatment threshold. A couple have said now, and a couple have said later.

[Magnus1964 in reply to ElRanchoDePoisonIvy]

You are still young, avoid radiation as long as you can. The term effects are not pleasant. If needed switch to another ADT drug.

[Magnus1964 in reply to ElRanchoDePoisonIvy]

If possible switch to another ADT drug. However, your PSA is still low so you don't have to take that step yet.

[ElRanchoDePoisonIvy in reply to Magnus1964]

I’m not on ADT. Most of the ROs are recommending I do that at the same time as rad.

[Magnus1964 in reply to ElRanchoDePoisonIvy]

Do the ADT drugs first. If needed, cryosurgery if you qualify.

[Tall_Allen]

They usually start ADT 2 months before radiation because lab tests showed that cancer cells are more easily killed when the AR is inactivated. It is continued afterward to clean-up whatever cancer cells survive the radiation. The duration is the subject of many clinical trials:

prostatecancer.news/2023/02...

Testosterone recovery depends on baseline testosterone and duration of ADT. Remember that only castration-level testosterone inactivates the AR. Just having low T is not enough.

[Justfor_]

I am with Magnus on the irradiation risks/rewards. You are probably aware of my Bicalutamide Maneuvers thread. If mistaken, you may find out what I elected doing at a similar crossroad as yours 20 months back.