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ADT started before SRT or concurrently?
Prostate Cancer | Last Active: May 7 7:43pm | Replies (17)Comment receiving replies
There have been studies looking into whether it’s preferable to front-load ADT as part of radiation treatment or to backload it.
This is a paper titled - “In Prostate Cancer, ADT After RT Better Than Before RT” - that was presented at the American Society for Radiation Oncology (ASTRO) 2020 Annual Meeting —> http://www.medscape.com/viewarticle/940049)
It discusses whether (and why) ADT with (and after) RT leads to better outcomes than ADT well before RT (which is how it is usually given).
The study’s conclusion favors an adjuvant-based rather than neoadjuvant-based approach, and it has to do with ADT’s continued suppressive effects after radiotherapy to help radiation kill prostate cancer cells.
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We had read similar papers prior to beginning my proton radiation treatments (during April-May-2021), indicating (as this paper states) “… starting ADT with radiotherapy significantly improved meaningful outcomes for patients, compared to starting ADT months before radiotherapy.”
So we didn’t start my ADT many months ahead of radiation treatments as some do. We started Casodex, then 6 days later started Eligard, then 5 days later started proton radiation. With two 3-month injections, the ADT remained in my system for 8 additional months after radiation treatments ended, so that the majority of my ADT was back-loaded to occur after radiation treatments.
Today, we’re 5 years past those proton radiation treatments. Things have gone very well (just as planned and expected). So far, so good!
Replies to "There have been studies looking into whether it’s preferable to front-load ADT as part of radiation..."
@brianjarvis
Thank you for sharing your experience and for the interesting article. Besides the Casodex and the Eligard, at what point was your first ADT injection administered? Was this before starting your radiations or at the same time?
Good to hear that things are going well for you and my Best wishes that they stay that way.
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@brianjarvis
Thanks Brian for this info. I tried to find studies done for salvage RT and could not find any. The closest that I found was this on UCLA site :
"Researchers observed a significant interaction between ADT sequencing and RT field size for all study endpoints except overall survival. For patients receiving prostate-only RT, ADT occurring during and after radiation was associated with improved metastasis-free survival compared with neoadjuvant/concurrent ADT.
However, with patients receiving whole-pelvis RT, no significant difference was observed with ADT sequencing, except greater distant metastasis occurrence among those who had concurrent/adjuvant ADT. "
This statement is also referring to initial whole prostate RT (primary RT) , but the last sentence refers to the "whole pelvis" RT which is actually more similar to salvage RT, I guess ?
I you happen to have any papers that refer specifically to salvage RT and initiation of ADT timing, please post them here (when you find time) - thanks so much in advance 🙏.