Amar Kishan, MD, on Optimal Sequencing of ADT With RT in Nonmetastatic Prostate Cancer

[Yearofthecow]

"For patients with nonmetastatic prostate cancer, the optimal sequencing of short-term androgen-deprivation therapy (ADT) when delivered with radiotherapy (RT) has been uncertain. Only two randomized trials have investigated this question. Now, however, a study in the Journal of Clinical Oncology, has provided more definitive evidence.

Amar Kishan, MD, of the University of California Los Angeles, and colleagues pooled individual data from 7,409 patients in 12 randomized trials. The patients were treated with RT and short-term neoadjuvant/concurrent ADT (n=6,325) or concurrent/adjuvant ADT (n=1,084), and outcomes were examined by RT field size.

In men who received prostate-only radiotherapy (PORT), concurrent/adjuvant ADT was associated with improved metastasis-free survival (10-year benefit 8.0%, HR 0.65, P<0.0001) and overall survival (HR 0.69, P<0.0001).

"These data strongly suggest that when PORT is being delivered with short-term ADT -- as is recommended for men with intermediate-risk disease -- concurrent/adjuvant ADT sequencing should be the standard of care," the researchers concluded."

medpagetoday.com/reading-ro...

[Darryl Partner]

youtu.be/IeX-GF-nLqo(Not working as expected?)

[Yearofthecow in reply to Darryl]

Thanks Darryl,

John

[PSAed in reply to Darryl]

Thanks Darryl/TA

As you suggested in the video ....certainly in my case...I will watch it more than once as there is a lot to take in.

[backbonz]

well this is certainly relevant for me since I’m starting SBRT Monday. I was happy that Dr. Nagar said i wouldn’t need Hormone therapy in my case. (low-int risk) .

Now this makes me think.

And then you read stuff like this…

pubmed.ncbi.nlm.nih.gov/354...

[Yearofthecow in reply to backbonz]

Problem with the ncbi link is that it is based on retrospective data so it is hard to determine the harm or benefit, as opposed to a double blind study I believe

[PSAed]

Thank you for post Yearofthecow. I do not understand what exactly constitutes 'whole pelvis radiation" eg in my case I received "Radiation to prostate, seminal vesicles, and Nodes ,total of 78 Gy in 39 fractions" Does this mean I received whole pelvis radiation?

I ask because in your link Amar Kishan makes a distinction between PORT and "whole pelvis RT" when drawing a conclusion from Data.

[Yearofthecow in reply to PSAed]

I am not sure PSAed. I read PORT as only the prostate, while whole pelvis radiation would be the prostate plus the pelvic lymph nodes. My understanding is that the thinking among some is whole pelvic radiation is done as a prophylactic. I think because you had the lymph nodes done, that would imply whole pelvis RT. Perhaps others might add their thoughts here. Of course the easy answer is to ask your RO.

Take care,

John