Connect
New research on length of ADT therapy for patients with RT
Interesting article !!! What I got out of it is that if you take ADT longer than 12 months you may be less likely to die from prostate cancer and more likely to die from other causes. Oh joy !
Here's the article
Original Investigation:
Optimal Duration of Androgen Deprivation Therapy With Definitive Radiotherapy for Localized Prostate Cancer
A Meta-Analysis
https://jamanetwork.com/journals/jamaoncology/article-abstract/2841671
Like
Helpful
HugInterested in more discussions like this? Go to the Prostate Cancer Support Group.
Connect
@datasource You should demand a Decipher Score to actually measure the aggressiveness of your cancer. They did not have one when I was diagnosed.
It is totally unscientific and imprecise to call your cancer high risk or aggressive based on your PSA. Men have had PSA’s triple yours and no cancer was found on biopsy.
Especially with a small 4+3, the treatment with ADT all depends on the aggressiveness. I will go one step further and say that if your decipher score comes in very low you may not need ADT at all – and remember this advice is coming from someone who actually wanted it! Best of luck,
Phil
Thanks for the input, Phil.
However, while very high PSA doesn't always mean cancer, IF diagnosed with cancer, then any cancer with initial PSA >20 is defined as high risk...... per NCCN guidelines. Two oncologists at Mayo walked me through this when I questioned the rating.
Respectfully, I can't imagine Mayo doctors using "unscientific" data.
-
Like -
Helpful -
Hug
1 Reaction@heavyphil
I am going in for Early Salvage Radiation on the 23rd of August. My decipher score was 0.56. I had a RP 5 years ago and my psa has now gotten to .128. My RO is not recommending ADT! I also had an ArteraAI result of Low and it recommended that ADT was not recommended as there was little value in doing it? My concern is that .56 is pretty close to .6 whereas that is a high Decipher score and would probably recommend ADT? I have no other issues except that my tumor abutted up against the capsule but no EPE per the Path Report. Since .56 is pretty close to .6 is there a + or - or is the .56 a solid number and nothing to worry about? Thanks
@jamie1957
Their certainly is a + or - to those numbers but who knows. The decipher number's were statistically obtained. There are people under and over, it’s not concrete. Its how comfortable you are.
@jamie1957 I only wish I could give you the correct answer! I guess it comes down to which genomic test is more reliable- Decipher or ArteraAI.
Many out there would say NO to ADT but pessimists like me might want it for 4-6 months, like just to squeeze out a few more percentage points in my favor.
Also, your surgical pathology, Gleason score and overall volume should probably be considered.
My margins were negative, even though I had a ‘tiny’ break in the capsule. But what is tiny to a few PCa cells?
Good luck with a tough decision.
Phil
-
Like -
Helpful -
Hug
3 Reactions@heavyphil I hear you Phil. I wasn't going to do it after consulting with Dr Scholz and he felt I didn't need ADT. He said it would only add 5-8% to my treatment success. This was after Top docs at COE's Univ ofPenn & Fox Chase both recommended ADT because of high PSA (both going by NIH guidelines). What convinced me to do it was when I consulted with Dr Chang and told him what Dr Scholz said he put things in perspective and said in the prostate treatment world 8% is a lot! His thoughts were my treatment plan of HDR Brachy and SBRT is a very aggressive treatment and probably don't need ADT but a short course 4-6 months would still be beneficial.
-
Like -
Helpful -
Hug
3 Reactions@copyman Yes - 8% is a whole lot…many poo-poo a single digit advantage but if you were investing your $$, would you go for the 10% return or the 18% return?
True, the higher return comes with some risk (SE’s), but they are usually not permanent and there are tried and true ways to overcome them.
I think your RT and ADT regimen will totally do the job…Best,
Phil
-
Like -
Helpful -
Hug
3 Reactions@datasource No, you’re right about that as far as the guidelines are concerned.
But there are those very low PSA cases which turn out to be extremely aggressive, right? And cases where cancer is found along with BPH, also a driver of PSA.
I don’t know (and I have not checked recently) if the guidelines have been updated to take this into account…ie, have they added the Decipher score and others to the diagnostic criteria?
There must be tons of men out there with lower grade cancers, BPH and high PSA’s - some even on AS. Best,
Phil
-
Like -
Helpful -
Hug
2 Reactions@copyman I always look at the inverse for these. If your treatment has an 80% chance of 10 years no recurrence going to 88% is an additional 10%. However, looked at from chance of a recurrence the 20% went down to 12% for a 40% decrease. This can be applied to recurrence, metastases, death or any other success statistic available. Sometimes even these numbers get very small especially with extended (> 1 year) ADT for localized prostate cancer when the total effect on the body is considered (all causes mortality).
@ededed (Late reply) Yes, monitoring closely. Right now, whatever the article speculates, we don't have phase 3 trials showing that it's safe to go off ADT with stage 4, but they're underway. In my case, the LIBERTAS trial covers *exactly* my situation: stage-4 castrate-sensitive prostate cancer being treated with ADT and Erleada (Apalutamide). We should have preliminary results this fall. Small-scale retrospective studies and "may be optimal" are intriguing, but I need a little more than that before making a potentially life-threatening decision. I very much hope that the article you shared ends up being validated in full trials.