ADT duration for high risk with Cribriform

[Miko710]

Hi all,

Age 72. In good health. I'd like to get some advice on my case. Should I stop ADT after 12 months?

bmcurol.biomedcentral.com/a...

I just consulted with my RO. I’ve done 11 of 18 months on Eligard. He wants me to stay the course. He spoke about the possibility of microcancers, and my cribriform pattern. I’m tolerating the ADT side effects reasonably well, but I worry about the long-term. I did baseline cardio and bone density when I began SBRT. All normal. Taking lots of supplements (Calcium, Vitamin D etc), working out and I have a great pescatarian diet.

I’m “lower high risk”. See biopsy results below. T2A, T2B. Low PSA, never above 7.0. I did SBRT in July 2023. PSA was .05 three months post SBRT (October) and .01 as of March 2024.

The study above would seem to suggest that I can bail on ADT after 12 months. I'll ask him about the study, but I may look for other opinions.

MY BIOPSY DIAGNOSTIC (FALL 2022)

A: Right prostate biopsy (D2): • Benign prostate parenchyma.

B: Right prostate biopsy (D4): • Benign prostate parenchyma.

C: Right prostate biopsy (D6): • Small focus on high-grade intraepithelial neoplastic proliferation.

D: Left prostate biopsy (G1):

Acinar adenocarcinoma with a Gleason score of 8 (4, 4, 3),

Grade 4 cribriform pattern and glands malformed,

Group 4/5 according to WHO, occupies 90% (10mm). 60% (6mm), 70% (9mm), 90% (11mm), 30%

(5mm) from the surface of 5 of the biopsies.

Cribriform intraductal carcinoma.

Peri-nervous invasion.

One of the biopsies involves only fibro-muscular connective tissue.

E: Left prostate biopsy (G3):

Acinar adenocarcinoma with a Gleason score of 7 (4, 3), grade 4 (pattern malformed glands), Group 3/5, according to WHO, occupying 20% (3mm) of the surface of the biopsy.

F: Left prostate biopsy (G5): • Benign prostate parenchyma.

PMSA PET scan in July 2023 indicated that I actually had four tumours confined to the prostate capsule.

Thanks!

[Tall_Allen]

What is your question?

[Miko710 in reply to Tall_Allen]

Thanks, Tall_Allen. You're a great source of information. Given the study cited above, I'm looking for more info on why I need to survive ADT for six more months. I tend to follow my RO's advice- and will do so unless I have compelling reasons to question it.

[Tall_Allen in reply to Miko710]

What you cited is just a retrospective study of a non-random sample. Such studies are subject to selection bias - i.e., those who got shorter duration of ADT got it because their doctors felt for some reason that was all they needed. It is NOT something to make decisions on.

The clinical trial that proved the superiority of 28 months of ADT with escalated-dose radiation in high risk men was the DART 01/05 GICOR trial.

prostatecancer.news/2020/04...

If your SBRT dose was high and margins were wide, you may be able to get away with less.

[Miko710 in reply to Tall_Allen]

Thanks for this. Very helpful. I'll stay the course.

[kiyo in reply to Tall_Allen]

Tall_Allen, Thank you for sharing your news article about the trial. Would you please clarify what SBRT margins are considered as good and wide? My husband has decided to go with SBRT and his radiologist said he can get a 2mm margin, counting errors and motions. I do not know if 2 mm is a good or not. So thanks for your information.

[Tall_Allen in reply to kiyo]

With MR-targeted SBRT, they reduce margins to 2 mm.

[kiyo in reply to Tall_Allen]

Thanks for your reply. We just read that at a 2 mm PTV margin, at least 95% prescribed dose would be received to the CTV. That's assuring. Thanks again for the info.

[ToolBeltZia]

My thought is you have the cancer up against the ropes. If you are in fact tolerating the ADT , I would consider continuing it to hopefully deliver the "knockout punch".

[SimMartin]

I can give my experience and say that I had an initial G7 with <10% 4 one side only. After 18 months and 2 biospies and 3 contrast MRI it turned out to have g9 in the previous negative cores on the so called clear side - now my view is hit as hard as you can tolerate whilst constantly checking other metabolic issues regularly to inform your choices.

So I have stopped just short of 18 months of HT due to my own co-morbidities beginning to be affected for the worse. However had I been in your more healthy position I would have tried for 24 months from RT, or even 28 as per tall Allen’s answer - just my experience of how elusive PCa cells can be even with mri guided biopsies.

[Miko710]

Thanks for this. Sorry to hear about your situation. 11 months in, my PSA is really low (.01 c/o Eligard). Luckily, I had a PMSA PET scan c/o a 50/50 trial just before whole gland SBRT. As you suggest, ADT can have serious health effects, as well. I'll go with what my RO says and keep a close eye on my PSA going forward. Good luck!

[JAMES_BOND007]

If you bail on ADT after 12 months, note that you'll probably not recover testosterone for months afterwards, if at all. Three months for me and I'm still waiting. This study is a good reference. urotoday.com/video-lectures...

[Miko710]

Yes, I know. I guess that I'll cross that bridge when I come to it. The consensus is pretty clear in my case (18 months of ADT).

[gordy123]

had ADT for 12 months ,finished 2 years ago still zero testosterone, i am 78

[Miko710 in reply to gordy123]

Very sorry to hear that. I don't know if it would be wise to look at testosterone replacement? A bit scary after one has had prostate cancer

[j-o-h-n]

Go for the 24 karat not the plated gold..... BTW Ever think of getting a Medical Oncologist to test the karats?.........

Good Luck, Good Health and Good Humor.

j-o-h-n