Hope everyone is doing well. I’m on this site to gather information for my father. He has grade 9 cancer that has spread to nearby lymph nodes. Long story short, he received radiation therapy (RT) and was on hormone therapy for a few months before and during the RT. Now that the RT is finished, he refuses to take further medications, claiming that the side effects could potentially cause other diseases. He also seems to have a misunderstanding that RT alone is sufficient for this stage of cancer.
I’m trying to collect data points to help him understand the situation better. Could you share any articles or research papers that compare survival rates between patients who undergo RT alone and those who receive both RT and hormone therapy? Your help would be greatly appreciated. I’m pretty sure without any medications, he won’t have many years ahead of him, so I’m looking for something specific that I can share with him and hoping he could change his mind.
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Healing1826
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You might find this information helpful, as I have. There is a graph in this article that shows the different survival rates of continuous ADT vs Intermittent ADT. Generally the survival goes down at about the same rate with either case. After twelve years,, the survival rate levels off at about ten percent. The average survival is around five years.
Asked ChatGPT if it can summarize some statistics for patients with high risk and N1 and doing radiation with short term or long term ADT. ChatGPT is of course a tool and shouldn’t be read as ’absolute truth’ but could be good use in dialouge with the experts
The outcomes for high-risk and node-positive (N1) prostate cancer treated with short-term versus long-term androgen deprivation therapy (ADT) combined with radiation therapy vary depending on the studies. Below are some statistics based on clinical trials and meta-analyses:
Local Control and Recurrence
1. Radiation with Short-Term ADT (4-6 months):
• Local control: Around 70-80% at 5 years.
• Biochemical recurrence-free survival (bRFS): 50-60% at 5 years.
• Pelvic lymph node involvement: For N1 disease, the recurrence risk remains higher than localized disease without long-term ADT.
2. Radiation with Long-Term ADT (2-3 years):
• Local control: >85% at 5 years.
• bRFS: 70-75% at 5 years for high-risk patients and up to 80% for intermediate-risk N1 patients.
Clinical Trials Supporting Local Control and Recurrence:
• RTOG 8531: Showed that long-term ADT (lifetime or 2+ years) improved local control and delayed distant metastases for locally advanced prostate cancer, including N1 cases.
• EORTC 22961: Demonstrated a significant advantage of 36 months of ADT over 6 months in preventing recurrence and improving overall survival.
Overall Survival (OS)
1. High-Risk Non-Nodal Disease:
• With short-term ADT: 70-75% 10-year OS.
• With long-term ADT: 80-85% 10-year OS.
2. Node-Positive Disease (N1):
• With short-term ADT: 55-65% 10-year OS.
• With long-term ADT: 65-75% 10-year OS.
• Meta-analysis: Adding long-term ADT to radiation improves 10-year survival by ~10% compared to radiation with short-term ADT for high-risk or N1 disease.
Clinical Trials Supporting OS:
• STAMPEDE Trial: Long-term ADT combined with docetaxel or abiraterone further improved survival for high-risk or node-positive patients.
• GETUG-AFU 16: Demonstrated improved OS with the addition of 6 months of ADT to radiation for intermediate and high-risk patients, but longer ADT was more effective in N1 cases.
Metastasis-Free Survival (MFS)
1. Short-Term ADT:
• 5-year MFS: ~65-70% for high-risk or N1 disease.
2. Long-Term ADT:
• 5-year MFS: ~80% for high-risk or N1 disease.
• 10-year MFS: 60-70% depending on PSA, Gleason, and T-stage.
Clinical Trials Supporting MFS:
• SPPORT Trial: Boosted metastasis-free survival with long-term ADT plus prostate and pelvic RT compared to prostate-only RT with short-term ADT.
Disease-Specific Survival (DSS)
1. High-Risk Disease (Non-Nodal):
• With short-term ADT: 85-90% 10-year DSS.
• With long-term ADT: 95%+ 10-year DSS.
2. Node-Positive Disease (N1):
• With short-term ADT: 75-80% 10-year DSS.
• With long-term ADT: 85-90% 10-year DSS.
Clinical Trials Supporting DSS:
• DART 01/05: Showed that 28 months of ADT significantly reduced prostate cancer-specific mortality compared to 4 months for high-risk patients.
Conclusion
• For high-risk and N1 prostate cancer, long-term ADT (2-3 years) combined with radiation therapy provides significant benefits in terms of local control, metastasis-free survival, disease-specific survival, and overall survival, compared to short-term ADT (4-6 months).
• Adding newer systemic therapies like abiraterone, enzalutamide, or docetaxel in specific high-risk or N1 settings further improves outcomes.
• Short-term ADT might be appropriate for lower-risk patients or those with significant comorbidities, but long-term ADT remains the standard for N1 disease.
It at least shows you the actual statistical difference between somebody with high risk N1 cancer having radiation and the significant benefits of doing long term ADT compared to short term.
Then you probably understand that only doing radiation without ADT at all puts you even at worse statistics.
I had my prostate removed 2 years ago and my cancer came back a couple months ago. It is still localized so not the same as your father's but I do have Gleason 9. I am doing radiation only at this point. If it gets worst in the future I always have hormone therapy to fall back on. Hormone therapy does have side effects so taking it isn't without risks.
Would you please update your dear Dad's bio. All info is voluntary but helps him/you and helps us too especially if it's specific. Thank you!!!.
From your first post "My father is otherwise healthy, a few years from 70 years old".???? That's how I would describe my very best friend in the hole world when I first met a young lady that I liked.
What your father needs, imo, is an understanding of how prostate cancer cells grow, if not controlled. ADT controls the growth of prostate cancer cells by removing testosterone, the primary feeder of PC cells. I once calculated the size of prostate tumors if unchecked.
After one year, a tumor is about the size of a grain of salt.
After two years, it grows to the size of a sesame seed.
After three years, it grows to the size of a walnut.
After four years, it grows to the size of a basketball court.
After five years, it grows to the size of a city.
Of course, one dies before the fourth or fifth year, assuming no control. The immune system does fight against foreign invaders such as cancer, but in a limited way. Nevertheless, without treatment or medication, I would estimate life expectancy to be under four years.
You might also refer to Dr. Patrick Walsh's book, "Guide to Surviving Prostate Cancer", chapter 6, (Diagnosis and Staging). He gives estimates of outcome after prostatectomy (not RT) based on the PSA, Gleason score at biopsy.a nd various stages of the disease.
Here is a good website to compare odds of cure for the major treatment paths. You have to determine your stage, low risk, intermediate, or high risk (risk of recurrence). So if you are intermediate, pull up the intermediate chart and you can see the odds of 10-20 yr survival, etc. based on the treatment you pick.
It is best viewed on computer or just print it on paper. Not so viewable on phone.
To make the graphs easier to read, i drew a dot on the endpoints of the elipses, and then drew a line through the dots. This turns the elipses into lines.
Also be aware the the graphs don’t show any salvage radiation benefit. This would boost the surgery odds up a bit.
And, this is a very dysfunctional industry from my view. Loads of bad info mixed in with the good info. Same with the docs. Some of them are more dangerous than the cancer.
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Hormone therapy before radiation? Confused..
Chemo+ radiation+combo hormone therapy
First post: Father with metastatic PCa, looking for natural treatment experiences after stoping oral chemo/radiation. 
Stage 4 prostate cancer advice 
Startup develops late-stage prostate cancer therapy that could increase patient survival rates
