Radiation with or without ADT: efficacy and side effects

[ron_bucher]

Interesting study comparing radiation with and without ADT:

curetoday.com/view/ebrt-reg...

[street-air]

“It is unclear if six months of STAD in addition to EBRT can improve PCSS or OS for IRPC, or just merely delay PSA progression.”

ah yes. I wondered that. adt is a hell of a thing to go thru just to improve odds by a few percent.

[MorningtonCrescent]

That's just for 6 months ADT, two years of ADT shows a much better risk reduction

[street-air in reply to MorningtonCrescent]

well, if the goal is to be either alive at 10 years or met free at N years then would not stopping the cancer in its tracks for two years instead of 6 momths (well longer, really, as adt ended after two years often does not restart T) simply push more people in the adt group past the goal posts?

To look at it another way, if a motor is going to implode after 10-50,000 miles, then the group that dont use their car for two years - they “do better” than the group that do use it, by measuring who has a working car at the five year point. But can’t that better stats result still be simply a function of the delay, rather than the therapy helping a repair of the motor?

[maley2711]

I don't have the studies at hand, but I believe it has been fairly well established that for Gleason 3+4 , there is little if any benefit to the use of ADT, whereas for Gleason 4+3, unfavorable intermediate risk, there is a meaningful benefit.. For Gleason 8-10, lnger term ADT has significant benefit.....perhaps because there is much greater possibility of undetected micrometastatic cancer present at time of RT.

[ron_bucher in reply to maley2711]

I never heard that and would find it a bit shocking.

[maley2711 in reply to ron_bucher]

Actually SOC I believe.

file:///C:/Users/maley/Downloads/localized-prostate-cancer-intermediate-risk-plenary-slides%20(2).pdf

[ron_bucher in reply to maley2711]

The document you tried to provide appears to be on your computer so nobody can see it.

[maley2711 in reply to ron_bucher]

Here you go.....

nursinghero.com/study-files...

[ron_bucher in reply to maley2711]

Thanks. I find it very interesting that initial treatment decisions might vary between Gleason 3+4 and Gleason 4+3, because I've observed many cases (including my own case) where a Gleason 3+4 biopsy preceded a Gleason 4+3 prostatectomy pathology report.

[maley2711 in reply to ron_bucher]

That's the way it goes isn't it. Diagnoses have their limitations. Upgrades and downgrades are observed for RP pathologies. You chose RP, so the differenc disn't matter as far as the treatment protocol. I suppose that is an argument for having RP vs RT.......though don't recall having seen that point offered as a reason to choose RP. RT protocol very much determined by biopsy Gleason grade!!

[ron_bucher in reply to maley2711]

Another thing that doesn't get the attention it merits is that PSA is more informative/useful after RP, especially for anyone who wants to proactively/immediately jump on biochemical recurrence with additional treatments. That's exactly what I've done, and I'm really glad. But that's just me and my competitiveness against the beast.

[maley2711 in reply to ron_bucher]

Yes,, though I think men who choose RP quite often mention that exact reason. RP guys have many more actual salvage procedures than do RT guys......one reason some RT guys choose RT. At75, I was very averse to any type of surgery...and the deep sedation! That and the MUCH higher probability of long-term incontinence. My wife has that, and it sucks!! Avoiding the ADT with surgery would be nice!! If I die without ever having major surgery, I will not complain!!

[ron_bucher in reply to maley2711]

Yes, age is one of the most important variables in the decision making. And it also doesn’t get discussed as much as it should.

[kreg001]

”… freedom from biochemical failure (FFBF) rates were 52% and 49% in each respective arm …”. Guess I am irritatingly in the ~50%. Wish we knew why. Thanks for the reference.

[ron_bucher in reply to kreg001]

I read your bio. Keep in mind that spread of cancer occurs before (sometimes long before) tumors are visible in any scans. Has chemo ever been discussed?

[kreg001]

Yes. But there’s a progression in the SOC protocols. I’m at the ARI progression. Chemo a step or two or three away. The tumor board can’t agree on my TNM. 300? 301? I’m delighted Nubeqa has put the PSA down for now. Still, wonder how I got here from a 3,4 Gleason, ADT, and IGIMRT.

[ron_bucher in reply to kreg001]

I got docetaxel upon biochemical recurrence at PSA 0.06, and it helped give me 4+ years of undetectable PSA with only 9 months of Lupron. Not trying to compare our situations because they are obviously different, but medical oncologists have freedom to prescribe chemo when it's appropriate. I hope your insurance is not the "SOC" obstacle to best treatments available for your situation.

[kreg001]

I read your bio. It would have been good to know when the ‘smorgasbord’ of options surgery, robot surgery, EBRT, brachytherapy, cryotherapy, ultrasound, were presented to me. I chose EBRT rather than risk incontinence and that’s been the path.

Only started Medicare and supplemental in 2018 so probably could have done as you.

Oh well. Now I live with ADT and ARI. Doubt I can switch paths to chemo. I will bring it up though. Miss having T.

Thanks for your insight.

[ron_bucher in reply to kreg001]

I'm pretty sure Medicare would cover chemo for you. Does your medical oncologist have a lot of experience (hundreds of cases) with prostate cancer?

[kreg001 in reply to ron_bucher]

I switched from my original urologist and RO, in December, to a Cleveland Clinic team that includes Steven Campbell (surgery), wrote a popular text on urology, Praveen Pendyala a radiation oncologist, and Moshe Ornstein a medical oncologist. I asked Ornstein about docetaxel and he said we’ll save it, hopefully for many years.

They know how I hate Lupron and will try to get me away from it ASAP. Two have mentioned intermittent therapy. Ornstein keads a team of residents, PAs, and NPs. He’s treated many PCA and other cancers. Has clinical trials. Just read his book, ‘Cancer in Halachach’. Although I’m from a liberal Episcopal background, far from Orthodox Jewish faith, his explanations and discussions on cancer and decision making were excellent,

I’m confident the team is looking after me.

[Derf4223]

The study seems to be about intermediate risk PCa. Not advanced PCa.

[ron_bucher in reply to Derf4223]

I guess it depends on how you define "advanced" and whether the study might be relevant to something like biochemical recurrence after prostatectomy. Salvage radiation without ADT gave me another 7.5 years of undetectable PSA.

urologyhealth.org/urology-a...