Is Hormone therapy necessary With radiation

@klein505

Duke is doing a study using AI to determine who precisely would benefit from ADT treatment. Their past work indicated that only a small percentage of men benefit from ADT. Now they are trying to determine who these men are so that others do not have to suffer the ADT side effects and the damage it does to your body.

@jeffmarc What is the point of waiting? For primary treatment ROs routinely treat local SV, lymph, etc. in higher risk cases without any PSMA confirmation that there is any cancer outside the prostate. They just know from experience that it is highly likely to be there with Gleason 8 or even 4+3. The same could be done for RP patients on first recurrence since there is even better information about the stage of the disease, positive margins, etc. If no ADT is done with the radiation another PSMA scan can be done after the treatment if the PSA does not become undetectable. Once ADT is removed from the initial BCR treatment follow on PSMAs can find any additional spots as fast as waiting with less risk for the majority of patients. Kwon stated that only 1/3 of patients had recurrence ONLY in the prostate bed. For the first BCR the percentage that had recurrence only in prostate bed, PV, local lymph nodes will be much higher.

Hi Jeff - I know you have had reoccurentssise - just wondering high your tetestrone was when this happened. I was Gleason 8 SI invasion pas 47 - currently on orgovyx 14months ' 3psa test - <.006 - not sure benefit of adt after 1yr. I'm waiting on decipher test before I make decision. Ty Gary

@pesquallie

Thank you pesquallie, so good to know that these studies are being conducted.

@brianjarvis
I have seen both Kwon and Scholz Talk about the exact same thing at PCRI. I watch all their conferences. One key is this statement “ have recurrence only in the prostate bed”. The word only is a real key factor. What percent have it in the prostate bed and elsewhere, But the pet scan can’t find it anywhere. Kwon and Scholz both talk about doing PSMA PET scans until something shows up and then zapping it. I would not be comfortable with that as the only treatment.

In those cases, it would make sense to radiate the prostate bed, and close by lymph nodes, because that would get rid of Some of the future issues.

I have posted in other messages a study that showed that people with advanced cases need to have Salvage radiation by the time the PSA hits .25 or it has a significant impact on their PFS.

Because of the relative late reimbursement for PSMA PET CT scans the information and advice must be in that context, i.e., BEFORE or AFTER their general availability and use. Studies, even randomly controlled trials (RCTs) before PSMA PET CT scans are the bases
of much of the Standards of Care ('SOC'). They may have to yield
to the consensus of very qualified clinicians.

@jim18
Some people do have severe reactions to ADT. Some people can take it without so much in the way of detrimental side effects to their daily lives, I am one of those . Long term it causes detrimental problems for everybody.

You seem to be discussing treatments that weren’t part of this initial message. Doing PSMA PET scans wasn’t discussed.

Pet scans are done initially in cases where people seem to have advanced cancer, but don’t have biopsies yet. I some of those cases they find quite advanced Cancer with many metastasis. At that point, they do triplet therapy and don’t even bother treating the prostate or doing a biopsy, So they have no idea what the Gleason score is.

Whether or not a PET scan is done ahead of time is based on what is found in the MRI and biopsy. Sometimes those results call for a PET scan, no matter what the Gleason score is.

While Kwon did say 1/3 of patients had reoccurrence only in the prostate bed, That doesn’t preclude the fact that many people will have it in the prostate bed and other places. But the PET scan doesn’t show anything in most of those cases. Is it wise to not do salvage radiation? Studies have shown if people have very advanced cases not doing salvage radiation by .25 causes shorter PFS. You can then wait around for other metastasis to show up, I personally would want and did have salvage radiation when my PSA hit .2.

Very good information. Thank you @jeffmarc

One question I still have is about the magnitude of the survival benefit for patients who receive treatment when their PSA is greater than 0.5. Is the benefit truly significant, or is it relatively small—for example, an improvement from 82% to 85% survival?

A second question that this study does not appear to address is whether patients with high-risk disease (either biologically and/or pathologically) derive a significant benefit from ADT, as Dr. Kishan and others have suggested in the past.

Jeff,
I know most studies always discuss PFS, Progession Free Survival which is different then OS, Overall survival. When I do see these mentioned together there is often little statistical differences between PFS and OS at five or ten years, yet going for the certain treatments always recommended for Standard of Care seems to rely on those PFS results over OS results. Often times the difference’s in treatment approaches can mean significant side effects for what appears to be little overall gain in benefit of survival by some of these studies just show differences in months. I feel it is so important for the second opinions and not to feel restricted by the National Cancer guidelines which make it so easy for Oncologist’s to say this is your recommended treatment and not really compare alternatives since Standard of Care does not offer other options with maybe less side effects even if the Standard of Care is arguably not that much better. Is it reasonable in a situation which certainly they are all different for individuals and their degree of their PC to say look PFS and OS are really not much different in this situation although the SOC based on the PFS studies will likely result in certain side effects, yet since OS is not much different in going another route with less side effects ho that approach.
Do you see much discussed regarding PFS and OS.

When i mean comparing the clinical studies between different treatments there is often just months differences between the PFS or OS when looked at between the two.