ADT and PSA with salvage radiation--things that make you go "hmmm..."

[dentaltwin]

Doesn't this contradict the conventional wisdom?

medpagetoday.com/meetingcov...

[Tall_Allen]

That's pretty much what RTOG 9601 said - no benefit to adjuvant ADT for PSAs below 0.7 ng/ml (Figure 3). Some ROs use a lower limit, though.

nejm.org/doi/full/10.1056/N...

A retrospective study likewise affirmed that adjuvant ADT (goserelin) was only beneficial for those with higher PSA (≥0.4 ng/ml), Gleason score 8-10, stage T3b/4.

pcnrv.blogspot.com/2018/01/...

Similarly, Fosatti identified PSA≥0.5 as one of 3 risk factors (along with Stage ≥ pT3b and Gleason score ≥ 8 that indicated a benefit to adjuvant ADT along with salvage radiation.

pcnrv.blogspot.com/2016/08/...

[dentaltwin in reply to Tall_Allen]

Thanks. In the first paper NEJM--I should read for comprehension. That finding (as with the Gleason score) is intuitive, but--it's a bit buried under the headline finding.

[Tall_Allen in reply to dentaltwin]

I agree, but it is understandable in historical context. Remember that these RCTs were begun many years ago (well before uPSA was used), and the first question to be answered was: does adjuvant ADT to salvage SRT add anything at all? Finding subgroups was a secondary objective. Arguably, SRT dose escallation may obviate the need for adjuvant ADT. The "problem" with prostate cancer is that it takes so long to kill the average guy with locoregional PC that research results may become irrelevant by the time they are ready.

[Murph256]

Those are disturbing results for me. I fall into the range in question, with a PSA of .55, when I was prescribed 24 weeks of ADT along with 8 weeks of SRT, 7 months after my RP.

According to the radiologists and oncologists at MSK, there is a significant benefit to adding ADT to salvage radiation.

According to MSK’s Stevenson monogram for salvage radiation, my chances of disease free progression 6 years after SRT increase from 28% to 54% when ADT is included. This seems like a statistically significant increase. Also it should be noted that I was given 24 weeks of ADT, which is <6 months of ADT, with the hope that the LT side effects of the ADT would be reduced, due to the shorter duration.

I hope and assume MSK ‘s nomogram is based on real statistical evidence. I’m not sure why the results differ so radically from the studies you linked.

mskcc.org/nomograms/prostat...

Also, it should be noted that I was part of a clinical study at MSK. I was randomly assigned to the control group that received Lupron , Bicalutimide and SRT. The experimental group received Lupron, Abitaterone, Prednisone, Apalutamide and SRT.

[dentaltwin in reply to Murph256]

You mean progression-free survival? Apparently, this evidence if pretty new. A quick look suggests none of the papers cited by Tall_Allen are from prior to last year. Also, the NEJM paper seems to show that overall survival at 12 years is not significantly different for those on ADT or not. So if you buy those numbers at worst you probably weren't hurt by the ADT. When were you treated? Maybe Allen will comment again.

[Murph256 in reply to dentaltwin]

I stopped the ADT last month. I’m waiting for my testosterone levels to recover to see if the radiation worked.

All my blood work has been good. In fact my weight, blood pressure, blood sugar and cholesterol have fallen significantly. Only my platelet and lymphocyte levels are low, but that’s due to the radiation, not the ADT.