If one has rapid PSA after salvage radiation, and no metastases on conventional imaging yet, there may be an advantage to adding short-term (8 months-1 year) therapy with a 2nd line hormonal agent (Zytiga, Xtandi or Erleada):
Short-term androgen annihilation in n... - Advanced Prostate...
Short-term androgen annihilation in non-metastatic recurrent men delays progression
Thnx. TA. Good to know for future reference. My son is undergoing SRT with ADT at the present time.
I was advised two years ago to forego ADT. My situation was a high risk Decipher, positive margin, and very low PSA (.03) at the time I started adjuvant RT. Studies at that time showed that ADT could be more detrimental than beneficial for low PSA patients. So far, so good for me, but what is the current post prostatectomy guidance being offered to guys with adverse pathology and high risk decipher whose PSA has just started to creep up? Has it changed?
I understand. I was simply asking if RTOG9601 was still the guiding light, to any extent for ESRT or SRT with low PSA. If my RT should fail at some point, sounds like this new work you’re citing may apply. As always, thanks Allen, I appreciate what you do.
Still not getting your news letter. Strangely when I just entered my email to subscribe it gives error message that I am already subscribed
Just making sure I understand this. The 21 month follow up was after the end of the one year treatment period?
yes
Ok. Is this the preferred next step after PR and SRT if PSA starts rising? One year of enduring ADT for two more years after that of relief. The other study you cite using abiraterone looks more like a 3:1 benefit, where apalutamide is only about a 2:1 benefit.
Are side effects much different between these two? Last, since the follow up was done at 21 months after stopping ADT, how do they know Group C was 26 mo. until BCR after stopping?
You can't compare across trials - different patients. But the bRFS were identical anyway: 25 months for apalutamide and 27 months for abiraterone (not significantly different). Apalutamide wasn't tested for 8 months, it was only tested for 1 year.
Side effect profiles are similar, but they've never been directly compared.
Median follow-up was 21 months. bRFS is determined from the Kaplan-Meier curve. Longer-term follow-up is planned.
Thank you, Allen
TA, always good advise. Thank you