Hello All, Would you please give your opinions on the proper ADT duration for me? Gleason 4+5=9, diagnosed in Fall 2019 at age 57. As far as they could tell from MRI and Cat scans, it's confined to the prostate with no distant nor local metastasis. Treated with external beam followed by brachytherapy, for a total biologically equivalent dose between 170 and 210 Gy. Been on ADT for 18 months so far, two of which were BEFORE the radiation started. PSA went undetectable in 3rd month of ADT and has been undetectable for the past several measurements.
I believe that the standard of care for high risk fellows in the US is 2 years of ADT. But I'M SICK OF THIS ADT.
You all helped me deal with it, with suggestions on diet and exercise. London441 encouraged me to do weight training, which has helped!!!
But I'm still SICK OF THIS ADT. And If I get biological recurrence guys, I'm just going to ride it out. I'm not going back to medicines, they just take too much out of me. I've had a good life.
I've read Nabid, Nguyen, Sidiqqui and others. It's clear that the range is 18 month to 2 years for a case like mine.
Sorry to be a cry baby. I should be thankful to still be alive.
I am thankful for the advice given so far in this group.
What would you do if you were me?
Siddiqui and Kraus say 24 months:
Nabid et al say that 18 months could be a valid option, but when you look at the data closely, you see that biochemical recurrence is worse for 18 months compared to 36.
Commenting on the Nabid article, D'Amico and Xie state that 18 months ADT could be a valid option for healthy men treated with a brachytherapy boost, OR (on the other end of the spectrum) men with cardiovascular problems.
Nguyen says 24 months, comparable to the ASCENDE-RT trial.
Morris et al say 24 months: sciencedirect.com/science/a...
McKay et al (ascopubs.org/doi/full/10.12...) say "Guidelines from several panels, including ASCO, American Urologic Association, ASTRO, and the Society of Urologic Oncology, generally recommend prolonged ADT for men with high-risk localized prostate cancer (24–36 months) rather than a shorter duration of therapy."
Fang and Zhou say "2 to 3 years," doi.org/10.1111/ajco.13108
Joseph et al show that 18 months is better than 6 months. doi.org/10.1016/j.ijrobp.20... (Thanks to Tall Allen for pointing this out and for referring me to his blog summary on the subject: prostatecancer.news/2020/04...).
Lazarev et al mention that 9 months can be acceptable in cases like mine (high-risk, no metastasis, treated with high doses of radiation achievable with brachytherapy boost) ! This is just a conference proceedings, but I want to ask them for a pre-print with data.