it seems that all prostate cancer patients with localized tumor(s) with Intermediate Risk should receive the ArteraAI test to prognosticate/predict how ADT would impact 5, 10, 15 years metastasis. It seems about 2/3 of these patients do not receive any added benefit from ADT therapy.
There are many tests to provide more understanding on a patients prostate cancer that can help determine appropriate treatment modalities. Patients should learn about all available tests and insist they receive them. (Decipher, Artera, Prostox, PSMA, etc. )
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Bourbon2024
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The problem with Artera AI is the endpoint they chose - metastasis free survival at up to 15 years. That is fine if you are 80 years old or you have other health concerns. But for the average intermediate-risk man who has failed after a prostatectomy at 60 years of age, he is more interested in being cured with salvage radiation. If he can be cured with 4-6 months of adjuvant ADT now, he can be spared the pain and crippling of getting metastases 20 years later.
Unfortunately they are not yet able to make that determination (despite publicity to the contrary). We had them run the test and the only thing they could say was "you are high risk". We knew that based on PSA, Gleason, Decipher, etc. They said they hoped to have the the predictive capabilities about length of adt available by the end of 2024.
That's interesting (and concerning). I'm thinking of getting the Artera test to see if I'm one of the 66% of men that don't benefit from doing ADT. But, it sounds like they didn't provide that information to you. Am I understanding your post correctly?
Correct. This was what we were told: "While the test did confirm you have high risk disease, it unfortunately did not provide us with the answer we were looking for on long versus short course of therapy.
Dr. xxxxx did speak with one of the representatives at Artera who confirmed this feature will not be available until the end of 2024."
Didn't ask that question as ADT was indicated with high risk. Our only question was how long. Many of the studies say short term is 6 months or less, but when referring to "long term", that can sometimes be 12, 18, 24 or even 36 months. We were hoping that Artera could lend some clarity.
You may want to look into doing estrogen patch therapy (EPT). It doesn't have the problems with the previously used Oral estrogen therapy. There's a current phase-III study (PATCH trial) that is showing very favorable results, compared to Lupron injections. The long-term final results should be published this Spring. EPT still castrates you the same as Lupron, but EPT doesn't have the bad side effects of Lupron ADT. In particular, doing EPT has no osteoporosis, no lipid changes, no increased fat deposition, no increased insulin resistance, no memory loss, and no hot flashes. EPT does not help with ED or loss of muscle mass/strength, however. I don't know about libido side effects, though.
If you send me your email address, I will send you 10 papers on recent estrogen patch therapy.
Bob I am the guy who discussed the AI test results in the NEJM. After reading the above post I just wanted to mention that you hopefully are not confusing short vs long term effects on ADT use.
All those scary things you mentioned like heart issues, bone loss, etc are found in long term ADT use. These are not a short term ADT issues.
It sounds like you are still in the preliminary decision phase so here are my thoughts and experiences on radiation and short term ADT impact and how I overcame them.
Regarding your ability to overcome weight gain, ADT and radiation fatigue, muscle loss and hot flashes on ADT in my experience by watching your calorie intake and doing resistance training and HIIT or extended Phase II workouts you can overcome those issues or at least reduce them to a manageable level.
Once again in my limited experience doing that allowed me to lose 12 pounds and drop 2” off my waist. Although I was not really out of shape for someone who is almost 80 I am now weight and muscle development wise back to where I was playing college ball some 60 years ago.
If you decide to go that physical and diet enhancement route I would suggest you start immediately for best results. It takes time to develop good habits and consistency.
Really nice talking with you and best of luck with your decision making and overall results.
I appreciate the feedback. That's a good point that the side-effects of short-term ADT are less worse than long-term ADT. I'm currently going to the gym 3 days a week, but will likely have to increase that to 5-6 days a week when on ADT. I convinced Dr. Kishan at UCLA to replace standard Lupron ADT with estrogen patch therapy. I'm looking forward to reading the results of the Phase-III PATCH trial in the UK.
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