SRBT and EXTEND trial

[Purple-Bike]

Does anybody have the full text of EXTEND trial results from June 2023? (my payment attempt is rejected and the tips on how to get a study without cost doesn´t work)

pubmed.ncbi.nlm.nih.gov/370... Addition of Metastasis-Directed Therapy to Intermittent Hormone Therapy for Oligometastatic Prostate Cancer: The EXTEND Phase 2 Randomized Clinical Trial

TA wrote in 2023, perhaps after the new results from the trial: "Tang et al. conducted the EXTEND trial at MD Anderson to see if SBRT to oligometastases could extend the ADT vacation without risk. 87 oligometastatic men were randomized to get ADT with or without SBRT. After 6 months, all were given a vacation from ADT. The vacation ended when PSA reached 20 or new metastases appeared. Those who got SBRT were able to take a significantly longer vacation before progression".

What I want to know is if many of the patients - in particular the 14 who were mHSPCa - took a longer time to get new metastases, or if it was only a matter of a longer time till PSA reached 20. This is not clear from the abstract.

In October 2022, before those results were published, TA wrote: "Another example of circular reasoning can be seen in the EXTEND trial from MD Anderson. They randomized oligometastatic patients to receive metastasis-directed therapy (MDT) + ADT or ADT alone. They only evaluated "progression-free survival" which, at 22 months, was almost entirely lack of PSA progression. They claimed that the lack of PSA progression made it safe to give patients a break from ADT".

[Purple-Bike]

TA, may I ask – are the results from the EXTEND trial presented in June 2023 Addition of Metastasis-Directed Therapy to Intermittent Hormone Therapy for Oligometastatic Prostate Cancerany any cause for changing your opinion in your newsletter from December 2020

“Pending confirmation from long-term randomized clinical trials of MDT/SBRT to oligometastases in bones, there is no evidence of oncological benefit” and

your update 10/26/2022 EXTEND only evaluated "progression-free survival" which, at 22 months, was almost entirely lack of PSA progression”. (i.e. not any real benefit from lack of metastasis progression)

The new results are 30 months out, do you know if the same is the case now - or could there be any indication of prevention of new metastasis by now?

Your (earlier) skepticism of the value of SBRT is strengthened by your newsletter from December 2022 showing (virtually) no prevention of pain or spinal compression from SBRT of asymptomatic spinal metastasis.

I am shortly to decide on systemic therapy without SBRT (no cost) or with SBRT (25 000 dollars plus travel) and to choose the latter I would like some (minor) evidence of benefit. I see scattered low-level evidence for this but the comprehensive studies you base your conclusions on point in the other direction.