New research on length of ADT therapy for patients with RT

@northoftheborder

Yes- it skews picture for younger patients. I think that AI will help with sorting out all of that massive and "collective" data in near future and help with making personalized protocols and plans. : )

Yes, genAI will either help refine the data or tell me I'll live to age 512. You never know with AI. 🙂

But I agree with you that it can be a useful tool for spotting trends in massive datasets, as long as there's close expert human supervision and review.

@northoftheborder

Oh, I am not saying that we should use AI ha ha , no way ! AI will give us at the end what we wish to read and hear if we play with it long enough ! ; ) Unfortunately there is zero education or information for general public about that fact *sigh

I am talking about doctors and researchers using AI for that - same way they use it now for MRI analysis etc. At Stanford they use it to scan mammograms now (I was told that last time I had a mammogram there).

There are big advancements in repurposing old drugs for new treatments and "off label" usage for different conditions for which was no help - AI helped with that. In right hands AI is a fantastic tool, in wrong ones - may lord help us all ....

@surftohealth88 Yes, I understood that in your original comment. Apologies for any confusion caused by the opening joke in my reply.

We're in loud agreement: genAI has the potential to be a powerful tool in the right hands, but never a replacement for human expertise.

@surftohealth88 Oops I was dialoging with North, my mistake. I try to keep it peer to peer.

@chippydoo

Unfortunately, there are built-in financial incentives for over-treatment. That is why I try to use medical professionalies who are salaried, like in major university medical centers. Even there, you have to do your own research, and be your own advocate.

My cancer was diagnosed Gleason 7 but Stage 3/4 due to activity in two nearby lymph nodes. I had 44 weekday radiation treatments and was originally prescribed 24 months ADT but it looks like that will be shortened to 18, taking a holiday next June and hopefully not having to resume treatment. I'm 74 and my family isn't known for men lasting much beyond 80. Stroke is popular among my relatives and my cardiologist is monitoring closely. At times, patients have been prescribed 36 months of ADT, but it seems that the longer time isn't significantly superior in outcome to 18 months.

Here is a discussion between two medical oncologists, of a presentation by Dr. Nabid, who has studied the effects of ADT for a long time.
https://www.urotoday.com/video-lectures/asco-gu-2023/video/3299-testosterone-recovery-in-patients-with-prostate-cancer-treated-with-radiotherapy-plus-adt-tanya-dorff.html
Eg. " what he showed that was really surprising was with six months of ADT, 75% of men recovered normal testosterone levels, but the median time to recovery was 18 months. And then even more surprising perhaps, with 18 months of ADT, only a quarter of men actually recovered to normal levels and the average time was out as far as five years."

Eg: "And it also I think put some of the radiation ADT trials in a different light in my mind at least, that the expected duration of testosterone suppression and the magnitude of benefit that we imagine with 18 months, with 24 months, it actually might be lifelong castration that's providing some of that benefit, which is a very different decision I think for patients."

Eg.: "we might perhaps be better being honest with our patients to say, "Well, we're going to keep going with the drugs for six months, but you're actually not going to have testosterone recovery for a year and a half."

Nabid's research has indicated that patients who recover testosterone survive longer :
https://ascopost.com/issues/march-25-2025/testosterone-recovery-after-androgen-deprivation-therapy-linked-to-improved-survival-in-high-risk-prostate-cancer/
The two urologists I've seen and the two radiation oncologists all have described ADT side effects to me as not much to be concerned about, saying many of their patients are doing fine....

@chippydoo it is unfair to assume your doctor requires you to visit to get your test results for his personal financial gain. Most of the care that physicians provide is done behind the scenes and not during face to face contact, all of which is time consuming, not to
mention the cognitive skills involved in monitoring patients and working to achieve the best possible outcome. Do you know of any professional who provides services free of charge or do you prefer a physician who is burnt out and under compensated to be providing your care? Most doctors spend an hour behind the scenes for every hour they spend in direct patient care. Many work 12-14 hour days when that extra time is factored in. Furthermore, the face to face encounter provides continuity of care and an opportunity for the provider to make adjustments to a treatment regiment based on observations that can only be encountered in an appointment setting.

If a person is uncomfortable with his/her doctor, then by all means find another provider. But don’t ascribe greed or a lack of compassion to a physician out of that frustration.

Even those countries with national healthcare coverage are not immune to patient frustration, and many who can afford it, have private insurance to allow them to seek care outside of the NHS, so that is not always a panacea.

And lastly, I am one of the first and loudest to encourage patients to seek care at an academic center, but because I believe that is where the best and most up to date treatment protocols are employed and not because the physicians are compensated any differently than those in private practice.

@climateguy Great post! I think a lot of these duration times are prescribed in almost cookbook fashion based on older research.
Wouldn’t a better approach be 6 months ADT (orgovyx)…monitor PSA…6 more months if it ticks higher even after ONE monthly PSA test, etc…rinse and repeat.
I don’t believe that a month or two off ADT while monitoring PSA is going to make a life and death difference.
Phil