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DiscussionShould I add ADT to Salvage Radiation at age 76?
Prostate Cancer | Last Active: Mar 26 6:43pm | Replies (30)Comment receiving replies
Replies to "One problem is that you’ve waited a little too long before doing radiation. As a result,..."
@jeffmarc Just saw a post on the Inspire forum where a patient with Gleason 4+5 and Decipher 0.98 consulted with Dr. Kishan who was involved in the POSEIDON study the ASCO recommendations about ADT were based on. Dr. Kishan noted that the POSEIDON study pertained to a general post-surgery population (i.e., all Gleason scores), whereas high Gleason scores are important in the decision making for the use of ADT. Also, for that study, men's Decipher scores were unknown and/or not used although high Decipher scores should be considered as well on the need for ADT with salvage radiation. See the complete post here,
https://www.inspire.com/groups/zero-prostate-cancer/discussion/bda128-adt-and-salvage-radiation-after-surgery/
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@jeffmarc Looking at the ASCO recommendations, it appears that the need for ADT with salvage radiation is driven primarily from PSA levels at the time of treatment. Whereas the need for ADT with radiation as a primary treatment is affected by numerous factors like Gleason score, Decipher score, intraductal, cribriform, seminal vesicle invasion, EPE or ECE (extraprostatic extensions or extra capsular extensions). The ASCO approach seems a bit simplistic to me to look only at the PSA level of a salvage radiation patient because if such a patient with many previous risk factors (high Gleason, high Decipher, intraductal, etc.) decides early to get salvage radiation treatment while with a low PSA value, ADT would automatically not be prescribed even though it might well be beneficial.