New research on length of ADT therapy for patients with RT

@rbtsch1951 I can hear him going room to room for 3 minutes at a time and pausing before entering with his scribe who had just given him the name of each patient handing him blood result papers. You weren't there so you don't know. #moneymachine

@chippydoo I truly am sorry that you have such negative feelings about your provider. That is not at all conducive to your wellbeing. The fact that his scribe is assisting him in keeping his day organized as he navigates from patient to patient does not mean he is uncaring or not responsibly thinking about you as an individual or mismanaging your care. Neither does it mean he is placing his finances above your health. Still, if there has been a breech of your confidence or trust, you should consider finding a provider with whom you are more comfortable.

The clinical trials they base the standard of care therapies on have to be based on old data because prostate cancer develops so slowly. I haven't tried to find out what these ideas about intermittent ADT are based on at this point, as its only been two weeks since I started taking Orgovyx.

So far I've been looking for info on what is known as to what length of ADT can benefit a GGIII, cT3b, SVI involvement, localized high risk prostate cancer case (i.e. mine), and what benefit that is.

It looks to me like the best approach for me is to see if I can get a definitive therapy that studies show that taking ADT for longer than 6 months has no benefit, i.e. EBRT + BT boost.

@climateguy That study you posted by Dr Stone made it pretty clear that there is no statistical difference in outcomes between 6 months of ADT or 30 when used with high boost brachy/EBRT.
My approach would be to agree with the RO to do 6 months of Orgovyx and then test the PSA every month for 6 months….then every three months for a year or two.
It’s totally reasonable and remember, it’s YOUR decision.
You seem like a pretty sharp guy and I would assume that you will be all over this so there will never be any big surprises.
Phil

@heavyphil First, I have to get an RO to agree to do EBRT + BT boost aiming for a minimum biologically equivalent dose (BED) of above 200 gray in the prostate. Stone's supervision of the BT boost applied in the TRIP trial resulted in a median 217 gray.

Dr. Stone directed all the participating centers in Japan for that trial to administer the BT first, so the actual delivered dose could be calculated, then the centers could adjust the amount of EBRT to add so the result was a total dose of more than 200 gray. He talks as if this is not the standard procedure, even in places where they routinely do BT boost. So this may not be that easy to get.

The prostate has to get a dose this high before the data shows that staying on ADT longer than 6 months doesn't add anything to the treatment outcome. A lower dose means more time on ADT, like 2 years, does add a benefit. Dr. Stone emphasized this in a panel discussion I heard.

Then I don't have to get anyone to agree to anything - I just stop taking Orgovyx after 6 months, unless someone with the stature of Dr. Stone (in my mind) talks me into some other regimen. I would tend to follow whatever PSA testing schedule my RO suggested.

My RO is a very distinguished radiologist who has my respect. I'm almost certain he knows Dr. Stone. He might convince me I actually am a poor candidate for the therapy and I might end up agreeing with his treatment plan. Although, the latest message from him seemed to indicate he's considering adding a BT boost to his plan for me.

One thing about ADT is there is a certain percentage of patients who get no benefit from any length of time on it due to the particular characteristics of their cancer. All the data my RO has about my cancer is subject to known rates of error. This whole process of figuring out the best treatment and carrying it out is a crap shoot. I'm glad to see that so many have put in so much effort over the years to improve our prospects.

My friend just had BT BOOST /cyberknife at Sloan. No ADT because of low Decipher. Best of luck!
Phil

Increasingly Docs are recognizing that in many cases both ADT and or its sister ARPI can be used selectively and intermittently. Suggest you Goggle the subject..
Here's a presentation by Dr Sean P Collins on an aspect of this. He treated me at Georgetown Medstar