@oldgreenpaint Thank you, the summary was good enough. You're right that this study supports extending ADT past 12 months if you have localised prostate cancer classified as NCCN "very high risk" and treated with radiation.

Highlights:

- this was a meta-analysis (reviewing existing patient data), so they couldn't set ground rules, interview patients, ensure consistent approaches, etc.; it's much less reliable than a clinical trial, but also far less expensive, and still helpful.

- it limited to localised prostate-cancer cases (as you mentioned), treated with radiation

- the median age of patients whose case files were reviewed was 70

- the risk from ADT side effects over time was linear, e.g. 2× as high after 2 years as it was after 1 year

- the benefit from ADT was non-linear, e.g. less than 2× as high after 2 years as it was after 1 year

The estimated cross-over points (where ADT risks outweighed benefits) — and thus, optimal ADT treatment lengths — for localised PCa after radiation were as follow, based on the cancer's risk factors:

1 intermediate risk factor: 0 months

2 or more intermediate risk factors: 6 months

NCCN high risk: 12 months

NCCN very high risk: undefined (i.e. no point was found where ADT risks started to outweigh the benefits)

Note: the specific benefit measure was the chance of preventing a distant metastasis within the next 10 years.

Cheers!