Interesting studies posted today on JAMA and JAMA Oncology

Thanks for sharing those. Just a note that the first link is a retrospective cohort study (basically, looking for patterns in older data), while the second link is a full phase III clinical trial, so they carry massively different authority and weight.

That said, I think the suggestion in the retrospective study is sound: that cancer treatment involving ADT + and ARSI (e.g. a lutamide) should include monitoring for metabolic syndrome as well as cancer progression. My onco isn't monitoring for metabolic syndrome symptoms, but my family doctor is, so I'm getting the recommended treatment, but not in a coordinated way (the Cancer Centre wasn't involved).

And for anyone interested, the second link (the clinical trial) compared different types of radiation therapy for treating early-stage prostate cancer:

- SBRT had a slight advantage in reducing bowel-related side-effects after 2 years
- SBRT had no advantage in reducing urinary-related side-effects overall after 2 years, but did show a slight advantage in reducing incontinence specifically
- SBRT showed fewer declines in sexual quality of life after 1 year
- SBRT did not improve disease-free survival after 3 years (in fact, it was slightly better for IMRT)

@northoftheborder

Thanks for the summaries. One thought as to disease-free survival. SBRT may well be moving toward a focal boost approach where the entire gland receives 36.25 GY (7.25x5) and the primary lesion receives a focal boost of up to 50Gy (typically 40-47.5Gy). Hypo-Flame and SPARC studies show an improved disease-free survival and a minimal increase in bowel and urinary side effects as compared to normal SBRT. I had the 36.25 with a boost to 40. I had a Barrigel spacer. My RO visualized my urethra on CT, MRI and PSMA-PET and used urethral shaping to keep the urethra from receiving "hot-spots". So far, 32 months later, bowel and urinary side effects have been and continue to be minimal.

Stay Strong Brother, We Got This

Thanks for posting the articles. The first one was timely and highlighted the need to proactively monitor key items. It supported the need to avoid hyper focusing on cancer cells only (which is easy to do).

@zmarkv I agree. It adds a little extra weight to the ongoing discussion about whether oncologists should be ordering and reviewing blood tests for things like cholesterol and HbA1C (diabetes) as part of routine monitoring beside the usual tests like PSA, instead of assuming that the primary care physician will take care of anything metabolic-related.

@northoftheborder

First, thank you for the summaries and conclusions of both articles, I had good intentions to do both but was a bit pressed for time. My medical oncologist is testing PSA, testosterone, as well as CBC and CMP. With ADT and my upcoming RT I need to ask him to just add a lipid panel and HbA1C to the list even though I'm not taking an ARSI. I have zero family history of diabetes, and my CMP two weeks ago was all green, but these ADT drugs cause havoc to our bodies. I totally agree that everything that can be monitored should be followed closely and frequently.