Should you start ADT after radiation treatment or not?

Posted by handera @handera, Jun 17 7:47am

AI is helping to answer one of the most difficult decisions a man faces after choosing radiation treatment for his PCa.

Do I need to start androgen deprivation therapy, or not?

The clinical information from 5 large phase 3 randomized trials was combined with digitized pathology slides from biopsies in which AI machine learning was used to extract features from the pathology slides, some of which could not be detected by a trained pathologist.

The ArteraAI biomarker that was developed and validated was able to show that 67% of men who would normally have been recommended for ADT would NOT benefit from this add-on treatment.

ArteraAI is the only predictive short-term ADT tool and the only AI tool recommended by the NCCN Guidelines® for Prostate Cancer.

Has anyone had this test performed? If so, what was your result and did it impact your ADT decision?
https://www.urologytimes.com/view/dr-spratt-on-an-ai-model-predictive-of-hormone-therapy-benefit-in-men-with-prostate-cancer

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

handera | @handera | Jun 17 7:49am

Here’s a link to the ArteraAI website:
https://artera.ai/for-patients

northoftheborder | @northoftheborder | Jun 17 8:40am

Is that a copy of their press release? It would be interesting to read some reliable third-party analysis.

handera | @handera | Jun 17 9:22am

In reply to @northoftheborder "Is that a copy of their press release? It would be interesting to read some reliable..." + (show)

Here’s the original report, almost 30 docs as authors:

“Artificial Intelligence Predictive Model for Hormone Therapy Use in Prostate Cancer”
https://evidence.nejm.org/doi/full/10.1056/EVIDoa2300023

northoftheborder | @northoftheborder | Jun 17 10:47am

Thanks you! It will be interesting to see if other studies confirm the findings. Long-term ADT comes with increased risk of heart disease, bone decay, type 2 diabetes, etc, so if our doctors can narrow down the situations where it's helpful, that will be a good thing. A single study doesn't get us there, but it's a start.

(Those of us with metastatic, castrate-sensitive prostate cancer *have* to take ADT to keep it under control, so the findings wouldn't affect me, but they could help when it's just a precautionary measure after treating early-stage PC).

handera | @handera | Jun 17 12:42pm

Sorry to hear of your CSPCa…I hope your ADT experience has been a “net positive” in your case.

You are correct, this test is for those initially diagnosed with localized PCa and wanting to know whether ADT, applied after radiation treatment, will help prevent “distant metastases” or not, in their particular case.

This research, however, is much further along.

In March of this year:

“NCCN guidelines…have classified (this test) as having a Level IB evidence rating per Simon Criteria. Additionally, the test is included as a Category 2A recommendation, signifying a uniform NCCN consensus on the usefulness of the tool as an option in prostate cancer.
https://www.urologytimes.com/view/arteraai-prostate-cancer-test-included-in-nccn-guidelines
It took the Decipher Test 15 years to achieve Level 1B status, however, due to fact that this work was done with clinical data already obtained from 5 previously completed Phase 3 randomized trials, it was “just” a matter of inputting thousands of digitized pathology slides, from the trial participants, and letting the AI do its thing and matching that analysis with the already obtained clinical data to obtain a predictive model.

In fact, Medicare now covers the cost of the test.

Bottom Line: For the first time, for those diagnosed with localized PCa and selecting radiation treatment, one can get a Level 1B evidence answer to the question:

“Will ADT follow up, after my radiation treatment, help prevent distant metastases of my PCa…or not?”

mike72 | @mike72 | Jun 18 6:14am

In reply to @northoftheborder "Thanks you! It will be interesting to see if other studies confirm the findings. Long-term ADT..." + (show)

Agree 💯 my PC is not localized and 4 years ago ADT was my best option .. my psa remains undetectable.. side affects are not pleasant but I live a good active life at 73👍

Scott M | @smurphympls | Jun 18 8:18am

I just finished a five fraction course of SBRT (TrueBeam STX) May 17. I was given a six month course of Eligard in February. I was localized, 3+4=7 Intermediate Unfavorable due to the number of cores 10/14 showing something. My RO wanted the ADT to work for a while to weaken/starve the PCa before radiation. Overall, aside from a few minor hot flashes that are diminishing, it really hasn't been a bad experience. However, my RO and urologist both advocated more strength training than I already did and more exercise/movement in general, as well as a cleaner diet.

That said, the use of AI in PCa treatment plans does interest me since I work in cybersecurity and data privacy, and AI is a tool with enormous potential in many areas. I presume they are training the ArteraAI on data supporting standard treatment plans. So it will be interested if they can develop more targeted, custom treatment options in the future. Thanks for sharing, and best of luck on your journey.

scottbeammeup | @scottbeammeup | Jul 28 7:16pm

I wish I had known about this before getting Lupron, which has been one of the worst experiences of my life. Doctors either ignore the side effects or pretend they don't exist.

northoftheborder | @northoftheborder | Jul 29 12:43pm

In reply to @scottbeammeup "I wish I had known about this before getting Lupron, which has been one of the..." + (show)

Is Lupron cheaper for U.S. insurance companies than Firmagon or Orgovyx, or is it purely a matter of which one the medical team thinks would be most appropriate?

Going from Firmagon (monthly injection) or Orgovyx (daily pill) has improved my quality of life enormously. I no longer have the huge swelling, the rash, or the 3 days of flu/COVID-like symptoms I got after every shot.