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Hormone therapy before radiation treatment question....
Prostate Cancer | Last Active: Mar 29 11:12am | Replies (39)Comment receiving replies
@climateguy Hi there - I'm just reflecting on your statement "ADT versus no ADT does not improve patient outlook by that much". Apparently it depends heavily on the risk group and the stage of the prostate cancer being treated.
While androgen deprivation therapy (ADT) is a cornerstone of advanced prostate cancer treatment, research shows its benefit varies significantly:
Low-Risk Disease: The statement is True. ADT provides little to no survival benefit for low-risk, localized prostate cancer and is generally not recommended as a first-line treatment.
High-Risk/Locally Advanced Disease: The statement is False. Adding ADT to radiation therapy (RT) for high-risk, localized, or locally advanced disease (T3/4) shows significant improvement in both disease-specific and overall survival.
Metastatic Disease: The statement is generally False, but nuanced. ADT is standard care, but modern treatment involves adding newer agents (ARPIs) to ADT to significantly improve survival over ADT alone
Replies to "@climateguy Hi there - I'm just reflecting on your statement "ADT versus no ADT does not..."
@stew80 I think your "low risk vs. high risk" distinctions are accurate.
I was sort of in the middle on the risk continuum. I was Gleason 4+3=7 unfavorable, PSA = 8.1 and more than half of my biopsy cores were positive. I used ADT for eight weeks before my SBRT radiation treatments and was so glad I did.
It's just my opinion, but I do think the ADT weakened the PCa and likely made my SBRT treatments more effective. PSA went to 0.1 four weeks after SBRT completion and it stayed there.
Yes, ADT sucks, but PCa sucks even more.
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@stew80 I wrote: "Exercise reduced the risk of cancer recurrence or death by 28%. ADT vrs no ADT does not improve patient outlook by that much."
I meant ADT does not improve patient outlook compared to no ADT, by as much as the 28% improvement found in the CHALLENGE study I was discussing. I didn't mean to imply that ADT was not a first line treatment.
I was thinking about my specific case, which has been summed up by my radiation oncologist as "cT3b". He also describes me as "at least high risk" although he has no evidence that it has metastasized except to the seminal vesicles. He has a senior position at an NCI designated cancer facility, and when I asked how much of a benefit I can expect if I accept his prescription for 2 years of ADT, he said 20%.
I realize that the benefit of ADT varies according to the stage of cancer that is being treated. However I agree with those who say now that evidence such as the CHALLENGE trial exists, it is time for the doctors and patients to change their attitudes to the benefits of exercise, from the current "it can't hurt", or it seems like a "good idea", to something as valuable in cancer care as things like ADT or chemo, i.e. first line recommended treatment, with recommendations and supervision paid for by insurance.