High risk and ADT duration since PSMA

[SimMartin]

What’s my fellow travellers thoughts / input re ADT duration for localised G9 having had moderately hypofractionated RT without pelvic RT based on the likelihood of no spread with negative PSMA/CT (misses 1 in 5 LN spread as opposed to old CT 1 in 2)

Therefore are the older 5/10 year studues had a much lower confidence that there was no lymph node involvement.

So does this add extra support for the RT + 18 month of ADT (rather than 2-3 years) for high risk localised PCa in the Canadian study ?

We will never know as research won’t be done on my situation as now surely SOC will be NOW be brachy plus RT plus probably a short course of combination HT agents.

[JohnInTheMiddle]

If you can boil your question down Sim to a clear statement then I think it would be easier for people to answer. As it is I'm getting a headache reading your situation and don't want to do the work of thinking for you.

[SimMartin in reply to JohnInTheMiddle]

Bit hard as I’m asking about the evidence for 18 months vs 2-3 years ADT with RT - when there isn’t anything definitive and now that would not be offered as bracy plus RT is becoming SOC which reduces ADT length. - just wanted a sense in others in my position that’s all. So apologies if I’ve been irritating.

[Tall_Allen]

I don't understand your post. From your profile, I gather that you have had salvage SBRT after failed HIFU. And your PSMA PET was negative? Or did you have brachy+RT? I really can't understand, sorry.

[SimMartin in reply to Tall_Allen]

my apologies- my major personality issue ! Too much verbosity and com pop lex thoughts that make it incomprehensible! Years as a psychologist reducing long research down to 1000 word journal submissions. I’d work on it but maybe beyond help at 73.

I had a negative PSMA followed by RT to prostate only. Now deciding if I can do 18 months on zoladex not 2-3 years, as a reasonable attempt at avoiding recurrence in <5-10 years so NO bracky as asked but told the HIFU scaring made it not appropriate/ possible!

.

[Tall_Allen in reply to SimMartin]

There's very little data that I'm aware of on salvage SBRT after local HIFU recurrence. I have only this:

ncbi.nlm.nih.gov/pmc/articl...

But I wouldn't think it would be that different from salvage SBRT after local RT recurrence. Most practitioners did not use adjuvant ADT at all or used it for a very short duration.

prostatecancer.news/2016/08...

This is consistent with the use of short-term (4-6 month) adjuvant ADT when used for men recurrent after prostatectomy only when PSA≥ 0.35:

prostatecancer.news/2022/05...

If you have reason to suspect occult metastases (high PSA, rapid PSADT), you may want to extend the duration of adjuvant ADT.

[SimMartin in reply to Tall_Allen]

thanks for that info - my oncologist has worked with salvage RT after failed HIFU at the centre in London UK, but I think as you say not enough yet for research publication. Also I seem to be a little unusual as I jumped to high risk G9 T2c after an favourable intermediate G7 T2a after the HIFU so even fewer cases to go by, and obviously I would have gone straight to RT had I had an indicator it was multi focal and higher risk.