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The NCCN PCa classification system vs new MMAI model
9,787 patients with localized prostate cancer from eight NRG Oncology randomized phase III trials, treated with radiation therapy, androgen deprivation therapy, and/or chemotherapy were evaluated in a multimodal artificial intelligence (MMAI) model for risk stratification.
The MMAI model, which integrated digital histopathology and clinical data, outperformed the National Comprehensive Cancer Network (NCCN) criteria by reclassifying 42% of patients, expanding the low-risk group and refining high-risk identification, as to a patient’s overall 10-year metastasis risk.
This approach would improve prognostic accuracy, reduce over treatment of low-risk cases, and ensure appropriate treatment for high-risk patients.
It holds promise for personalized care and is nearing clinical implementation pending FDA approval.
This new MMAI model has the potential to reduce BOTH over treatment and under treatment cases, upon PCa diagnosis.
This is an important development for the newly diagnosed. I hope it gets adopted quickly.
https://ascopubs.org/doi/10.1200/PO.24.00145
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Hey billfarm, did not see any mention of radiation along with your prolonged ADT.
Was radiation your initial treatment and that was why it could not be done again?
No focal mass to target. No radiation so far. Plan to use that when we can identify a target
Well, I did not have one focal target either - PSMA totally negative. But it has become standard to irradiate the prostate bed - and more recently to include the pelvic lymph nodes - in salvage radiation (usually in conjunction with ADT). These are the two areas in which rogue PCa cells are probably living. The success rate is very high.
I have never heard of being put on ADT with no type of radiation whatsoever after surgery; unless radiation was your primary form of treatment. Very unusual to me.
I have read a few hundred prostrate cancer case studies most of which from this forum. I believe there is a common pathway of treatments. Surgery or radiation with eventual psa failure. Then more radiation with or without short term adt. Then psa failure again at some point. The default then to tame the psa is adt 98percent of the time. Since I discovered the intermittent adt studies I postulate that is what most are doing without knowing it. ADT prior to radiation. ADT after psa failure etc etc etc.My independent thought is that when I have psa failure while on adt holiday I hope to get definitive scan target(s) that can be precisely radiated, ablated or in some way permanently dealt with. Call me crazy?
Additional explanation, hope for 2 or 5 fraction vs 7 wks of down time plus recuperation. I still run an active7day/wk business that I don’t exactly know how to retire from. The potential bladder and bowel issues wouldn’t be helpful either in my case. Drs are split on my path of treatment. Mayo radiologist was the most supportive of my logic. Lead oncologist also on board. Others worried about straying off standard protocol.
While I do understand your line of reasoning, You say “….and then PSA failure at some point” after either of the traditional treatments. There happen to be MANY successes with these treatments and only a certain much smaller percentage of cases go on to become totally ADT dependent (or castrate resistant, which is even worse).
If your reasoning is incorrect - and you do not wind up with “a few” areas to target, but too many smaller ones for which SBRT is not an option…what then?
We obviously disagree on treatment choices - mine is to hit it with the kitchen sink! - while your view is that both surgery and radiation may be superfluous, and ADT the true definitive treatment option. I guess your success/failure with your approach really depends on the aggressiveness of your cancer (Gleason, Decipher, etc) and I am sure you’ve considered all these factors in making your decision. Best!