"To the best of our knowledge, our study represents the first randomized effort to report the superiority, in terms of clinical progression-free survival, of SBRT and a [short course of ADT] compared with SBRT alone in metachronous oligorecurrent hormone-sensitive prostate cancer," wrote Jereczek-Fossa and co-authors."
Comments? (I'm heading to Dr Google to figure out what "metachronous oligorecurrent" actually is..
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Don_1213
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It proves that ADT should not be omitted with MDT (metastasis-directed therapy using SBRT).
Arguably, they found that delayed recovery of T may explain the difference. "The results of this analysis showed that, in our cohort, the advantage of the combined treatment group was no longer [statistically] significant when considering eugonadal progression-free survival for the SBRT with ADT group, " The ongoing PROMETHEAN trial is powered to correct for that.
"Metachronous oligorecurrent" means that patients recurred after initial definitive treatment (RP, EBRT, or RP+SRT) with up to 3 metastases that weren't detected at initial diagnosis
This study seems to start with the premise that MDT with. SBRT, delay systemic treatment implying it extends lives. In fact it says:
“..the new RADIOSA trial reinforces the role of metastasis-directed therapy in delaying systemic treatment escalation.”
Based upon your previous posts, I’ve always thought you had your doubts as to the efficacy of MDT, yet generally were in favor of it based upon the premise that it might work and it was generally safe. Is there anything in this or other recent studies that has made you more optimistic on MDT VIA SBRT?
I will take that as a ‘no’. You are clearly in the minority with that opinion now. Even AI, when asked the question says:
“AI Overview
Yes, studies suggest that metastasis-directed therapy (MDT), especially when combined with intermittent hormone therapy, can improve progression-free survival (PFS) and potentially extend life in men with oligometastatic prostate cancer. “
Interestingly, Dr. Scholz says the use of MDT (via SBRT) has transformed his practice and resulted in significant extensions in survival. Obviously that’s not ‘level 1” evidence but his clinical practice is pretty large. UCLA has a very large contingent of MDT via SBRT and from what I am told, they get very little pushback from the insurance industry. You would think insurance companies would fight paying for this relatively expensive treatment if there was no substantive evidence of efficacy.
I have great respect for you TA, so let me ask you the question in another way. Given all you know on the subject and if you were a betting man, would you bet that when all the final analysis is in, that MDT does in fact extend life? Or that it’s all a mirage?
Well, in hindsight I had (unknown) metastatic pelvic lymph nodes at the time of my RP and subsequent RT to prostate bed. Seven years ago yesterday, 06 March, I had metastasis-directed extended pelvic lymph node surgery, no ADT. Six pelvic nodes nodes including para-aortic confirmed cancerous. (Yes, I know, anecdotal).
Yesterday, I had latest uPSA draw - result 0.029. Previous two were 0.028 and another 0.029, respectively. Been holding 0.03X range since June 2021, no ADT. (Yes, I know, many do not support use of ultrasensitive PSA testing).
Had I done ADT with ePLND it seems logical I would have same result; would my treatment method and outcome still be anecdotal? All the best to all of us!
so delay T return with a period of adt, and then delay progression (big surprise /sarcasm) but also perhaps use up some of the valuable time the cancer will spend before it becomes fully castrate resistant? is this just re-arranging the chairs on a titanic?
No longer Uncle Google, now we ask our cousin A.I.
What is metachronous oligorecurrent"
ChatGPT said:
Metachronous oligorecurrent refers to a specific pattern of cancer recurrence. Let’s break it down:
Metachronous: This means that the recurrence happens at a different time than the initial cancer diagnosis, usually after a period of remission. It contrasts with synchronous, where multiple tumors appear at the same time.
Oligorecurrent: This refers to a recurrence of cancer that is limited in number and location, typically meaning a few (usually up to 3-5) metastatic lesions.
So, metachronous oligorecurrent cancer describes a situation where a patient experiences a limited number of cancer recurrences after a disease-free period. This term is often used in the context of metastatic cancers where treatment options like surgery, radiation, or systemic therapies might still offer good control of the disease.
Splashy headline but note they emphasized the importance of patient selection:
"...significant PFS advantage with ADT was not observed in those with a prostate-specific membrane antigen (PSA) concentration of 0-2 ng/mL, a PSA doubling time of more than 3 months, and M1a disease stage at baseline, along with patients whose time from first curative treatment to SBRT was more than 43 months."
It sounds to me like ADT tended to help only the more advanced cases, which intuitively makes sense.
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Statins and prostate cancer
