Basically finds that 6 months of ADT (with radiation) doesn't show superiority to radiation alone, while 24 months of ADT (with radiation) does usually show superiority to no ADT and 6 months of ADT. It leaves unanswered any questions about 12 or 18 months of ADT.
It also points out that none of this is written in stone. Some men do better with no ADT than other men with 6 months or 24 months of ADT, and vice-versa. They seem to feel this has to do with genetic differences and other disease factors...
QUOTE:
"It seems clear that some patients will benefit from short ADT versus no ADT, and some from long ADT versus short ADT," said Gillessen. "So the real question is, how do we better personalize therapy?"
Two potential approaches for determining benefit are the use of genomics and artificial intelligence based on pathology slides, she said. "Until these predictive tests are further validated, and widely available, we'll have to consider a combination of clinical factors, including age, comorbidities, patient preference, Gleason score, PSA doubling time, pre-salvage radiotherapy PSA, positive margins, and T stage, to decide on the addition of ADT."
ADT is not without toxicity, Gillessen noted, "so quality-of-life data will be interesting. Important is patient preference. One must balance between side effects of long-term ADT and the reduction of events."
I think this points out the need for an in-depth review of disease status at regular intervals with a medical oncologist, perhaps at 6 months to determine if it appears advantageous to continue ADT.
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Don_1213
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My humble take away......I don't recall exactly how these results compare to US results. some of the differences between long and short ADT are barely statistically significant?
Would need to see full study.....did they compare a reasonable number of men with Gleason 4+4 and Gleason 9 or 10.....did inclusion of lower risk men shade the results...I'd guess so..hopefully study looked at different Gleason risk categories and results for those..hopefully find full study to review!!
So, is the conclusion from this study not aligned with other studies/article I've read that suggest at least 18 mo ADT with radiation......and one study found 27 mo to be optimal for radiation + ADT? On the other hand, studies show that combo radiation with brachy + IMRT is equal or superior , and probably superior as measured by BCR, with just 6-12 mo of ADT???
Common sense that we'd like to have studies that let us know how to decide on ADT duration for each individual? I contacted chair of urology at MSK, and mentioned my concern with long-term ADT as part of radiation treatment. He suggested having a genomic test which, with admitted luck, would show a lower risk cancer that perhaps would allow more comfort with shorter course or no ADT with radiation. The Kaiser RO said genomic only after BCR????? I'm Gleason 4+5 very high risk, and additionally high 8.3 SuvMax seen in area of my PIRADS 5 prostate lesion......so risk short/no ADT based on a favorable genomic result???
Disease stage, pathology etc matter but when it comes to ADT, a good rule of thumb is to be in the best physical condition possible. A man who is fit and strong and eats well can usually tolerate ADT well, and it is proven to enhance the efficacy of radiation.
By contrast. a man who is substantially overweight or has one or more co morbidities probably should avoid it entirely unless absolutely necessary.
Of course in such cases improving one’s health has become absolutely necessary anyway. With or without cancer.
On short v None/Long v short, MFS differences were negligible in my view, and in OS, the long group had lower OS than the none group. Overall, I see no data here that would push someone to endure the ADT crap, and you live longer is you dont. Copied below from Renalandurologynews.com emails I get.
Short vs None
At a median follow-up of 9 years, short-course ADT did not prolong MFS compared with no ADT (hazard ratio [HR], 0.89; 95% CI, 0.69-1.14; P =.35). The 10-year MFS rate was 79% in the no-ADT arm and 80% in the short-course ADT arm.
Likewise, there was no significant difference in freedom from distant metastases between the short-course and no-ADT groups (HR, 0.82; 95% CI, 0.58-1.15; P =.24). However, short-course ADT significantly delayed the time to salvage hormone therapy (HR, 0.54; 95% CI, 0.42-0.70; P <.0001).
Overall survival (OS) was similar between the short-course and no-ADT groups (HR, 0.88; 95% CI, 0.65-1.19; P =.42). The 10-years OS rate was 86% in the no-ADT arm and 85% in the short-course ADT arm.
Long vs Short
Long-course ADT significantly improved MFS compared with the shorter course (HR, 0.77; 95% CI, 0.61-0.97; P =.03). The 10-year MFS rate was 78% with long-course ADT and 72% with short-course ADT.
A long course of ADT also improved freedom from distant metastases (HR, 0.63; 95% CI, 0.47-0.85; P =.002) and time to salvage hormone therapy (HR, 0.73; 95% CI, 0.59-0.91; P =.005).
However, OS was similar between the short-course and long-course ADT groups (HR, 0.88; 95% CI, 0.66-1.17; P =.38). The 10-year OS rate was 82% in the short-course group and 85% in the long-course group.
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