Am I receiving adequate treatment?

[Infamous9597]

I have completed one session of brachytherapy in Sept and am currently undergoing 25 sessions of whole-pelvis IMRT administered by MSK (details in my bio). Despite a low Decipher score, my cancer has adverse features, including cribriform and gross EPE. I am considering extending Orgovyx to a total of 12 months in hopes of achieving curative results. However, my radiation oncologist does not support additional ADT, even at my request. I would appreciate the team’s opinion on this approach.

[Tall_Allen]

I agree with you about 12 months.With "gross EPE (T3a & b)" you have high risk PCa.

prostatecancer.news/2022/01...

[Infamous9597 in reply to Tall_Allen]

Thanks, TA. Do you think it would be wise to add a second-generation ADT on top of Orgovyx?

[Tall_Allen in reply to Infamous9597]

No.

[BeHealthi in reply to Tall_Allen]

My husband also has PT3a, EPE and all the ROs we have talked to suggested 6 mos ADT. He has not yet starting his treatments but I would like to know if we should asked for a longer term of ADT when the time comes.

[NotDFL]

I wonder why the rad oncologist was against it. Your proposal could improve his 'success' rate.

[stealthrider]

The RADICALS-HD trial provided important insights into the use of androgen deprivation therapy (ADT) in combination with postoperative radiotherapy for prostate cancer patients who have undergone radical prostatectomy. Here are the key conclusions from the study:

Duration of ADT

The study found that 24 months of ADT improved metastasis-free survival compared to 6 months of ADT when combined with postoperative radiotherapy1

2

. Specifically:

The 10-year metastasis-free survival rate was 78% for 24 months of ADT versus 72% for 6 months of ADT1

.

This benefit was consistent across all prespecified subgroups, including baseline PSA levels2

.

Short-term ADT vs. No ADT

Adding 6 months of ADT to postoperative radiotherapy did not improve metastasis-free survival compared to radiotherapy alone1

2

. However, it did delay the time to salvage ADT2

.

Overall Survival

Despite the improvement in metastasis-free survival with longer ADT, there was no significant difference in overall survival between the 24-month and 6-month ADT groups after a median follow-up of 9 years2

.

Clinical Implications

The findings suggest that for patients receiving postoperative radiotherapy after radical prostatectomy:

Long-term ADT (24 months) may be more effective than short-term ADT (6 months) in terms of metastasis-free survival2

.

The benefit of long-term ADT should be weighed against the extended duration of potential adverse effects associated with ADT2

.

The reduction in salvage ADT with short-term (6 months) ADT may not be sufficient to justify its routine use2

It's important to note that long-term outcomes after radical prostatectomy are generally favorable, and the study was not powered to detect differences in overall survival3

. Future research may need to focus on higher-risk patients where improvements in outcomes are more urgently needed3

. These results provide evidence-based guidance for clinicians to better tailor treatment for prostate cancer patients following surgery, facilitating important discussions about the potential benefits and drawbacks of different ADT durations in combination with postoperative radiotherapy1

.