New research on length of ADT therapy for patients with RT

Yes .... Lately there is a trend to have shorter ADT treatments for this reason. PC patients fortunately live for many, many years, even decades and to get new data one has also to wait for many, many years to see the "end point" results.

I always thought that "PC Specific Mortality" should be the mayor factor in treatment decision, not overall survival. I always try to concentrate on those parameters and was surprised to see that actually PC SPECIFIC mortality gives somewhat different picture about certain treatments, actually more promising picture IMHO and that truly there IS such a thing as over-treatment and sometimes getting possibly one more year (15 instead of 14 for example ) perhaps is not so attractive if that one year is going to mean years of uncomfortable side effects.

It is all sooooo complicated and overwhelming and constantly changing but that is how it is - science and discoveries are evolving and that is good !

Thanks for sharing that.

I note from just the title that this applies only to people with early-stage (localised) prostate cancer who had radiation to the prostate

That makes sense. There's a low risk of recurrence in that case, and long-term ADT use comes with its own set of risks (increased chance of heart disease, stroke, diabetes, bone fractures, etc etc), so they need to find the right balance. Isn't 6–12 months typical after surgery or radiation for stage 1 PCa?

Those of us with stage 3/4 prostate cancer live in a different reality. Barring new medical breakthroughs, we're on this stuff forever. We do our best to manage the risks (frequent tests and monitoring, healthy, active lifestyle, etc), but if forced to choose, I'll pick maybe dying of heart disease in 20 years over probably dying of prostate cancer in 2. 🤷

@northoftheborder

Yes - absolutely !

It all depends on the aggressiveness and staging and metastatic patients have completely different protocols and approach.

I completely agree about choice between 20 and 2, here is discussion about "months" of possible difference, with emphasis on "possible".

However, when we had last consultations with RO he suggested 4 most of ADT with RT if we want adjuvant , even though my husband has aggressive cancer. And it was before he had his first PSA coming back undetectable. In previous decades he would be advised to have at least 6- 12 mos of ADT , as far as I know, somebody please correct me if I have wrong information about previous protocols.

Not to mention that I found study from 2020 where thay are debating should all patients have RT (?) after BCR depending of "fitness" and life expectancy (if it is less than 10 years and patient is over 75 with other health issues and slow PSA rise then RT might not bring benefit but bring toxicity ) and so forth, and so forth.

I think that in the near future there will be VERY individualized and customized protocols for every single PC patient depending of all possible factors beside stage and PSA and other now standard parameters. That is really very good and very encouraging indeed. For now we better stick with what is known and proven before "a brave new world" of customized PC treatments appear.

All of those new studies are just discussions and comparative studies BUT, some new trends are already "seeping" in practical realm of PC treatment.

@northoftheborder

The article states that for all stages of prostate cancer 12 months of ADT may be optimal.
I got from the title that it includes local metastasis. Local metastasis being within the pelvic cavity not distant metastasis.

From the article:
Note: DM is used for distant metastasis
" The optimal ADT duration based on 10-year DM was 0, 6, 12 months, and undefined for patients with 1 intermediate-risk factor, 2 or more intermediate-risk factors, and National Comprehensive Cancer Network high-risk and very high-risk disease, respectively."

BTW, when I was diagnosed I had local metastasis, PSA of 54.0, stage 3b,and subsequently had 42 IMRT treatments. I quit ADT after 12 months against my urologist advice four years ago. My PSA has hovered around 0.07 I do take a cup of Turkey Tail tea and vitamins daily.

@surftohealth88 My GU second opinion stated the greatest risk I have at this time is being overtreated. Chew on that. Private practice makes its living on as many visits as they can possibly get out of patients. As my private practice doc said if I allow them to get their blood results through the portal they won't come back. Yeah, come back for a 3 minute appointment if negative for $350. Pointless!

@chippydoo In many/most countries, doctors don't get paid per visit, so you'd need a different explanation for overtreatment. For example, I'm under the care of my family doctor and my cancer centre. The Ontario government pays my doctor a fixed amount per year for having me on her roster, so she makes the same whether I see her 1x or 20x. The hospital where the cancer centre is located gets baseline funding based on the number of people in the area it serves, and my academic oncologist is likely on salary, so he also doesn't get anything extra for more visits. Yet, to a large extent, we're following the same latest/best practices that you'd see at Mayo, etc. for treating prostate cancer.

@surftohealth88 Perhaps the reason they tend to use overall survival rather than PCa-specific is that many cancer treatments increase the risk of dying from other things (e.g. heart disease, diabetes), so they want to see how the benefits and risks balance out. But it definitely distorts things for younger patients: I mean, there's an elevated chance that an 85-year-old will die of *something* in the next 5 years, with or without prostate cancer, so mixing their overall-survival numbers in with those of people diagnosed in their 40s/50s/60s probably skew things quite a bit.

@northoftheborder North I am in the US and we pay by the appointment. More appointments more revenue. Blood work farmed out to a lab and my practice blocks them from giving me my results through my portal so that I have to come in for a $400 3 minute appointment to get a 2 number result 4 times a year. If I BCR again I will be switching from a private practice to a teaching hospital cancer center with a academic provider that is on salary. My wife has received fantastic care there.

To your comment to Surf I feel you are spot on. These drugs don't live rent free inside you . Side effects can take us out eventually. My urology practice won't even discuss that. Another reason to switch to an academic situation with a team approach.

@chippydoo That sounds like a very good plan. It's disgusting that the private doctor forces you into a visit to see your results. It's similar to how they make you come into the $$$ doctor's office there just for a monthly Firmagon injection (since I was in a wheelchair when I was on it, we did ours at home after a Public Health nurse trained my spouse; most people here go to an Infusion Centre. )

My reply was specifically about overtreatment. If someone wanted to determine how much overtreatment happens in the U.S. for the sake of profit, they'd have have to compare with patient treatment in other rich countries where institutions and doctors don't benefit financially (or at least, not significantly) by offering more treatment.

I don't think prostate cancer treatment in the U.S. is too different from other countries, for example, except that you do use expensive, premium procedures like PSMA-PET and proton-beam radiation a lot without any proven increased survival benefit (at least, not yet). There's also a joke that in the U.S. they'll give you an MRI for a sprained wrist, because there are too many MRI machines and they lose money if they're sitting idle. 🙂

Purely as an hypothesis, I suspect the biggest difference will be from the fact that big medical machines and their support facilities are capital investments in the U.S. and have to turn a profit or at least pay their way (even in non-profit hospitals), while in Canada, with a very few private exceptions, they're more like public highways or parks: they're there if you need them, but there's no financial incentive to push people into them.

This is far afield from my original post but I will share this sad story from a town not too far south of the Canadian/US border.
A man in a neighboring town put off seeing a doctor for more than a year because his job did not provide health insurance and he could not afford to self pay. He then won a $1,000,000 lottery prize. He went to the doctor who diagnosed stage 4 cancer. He died a couple of months later from his cancer that was diagnosed far too late to save him from an untimely death.
Yes, I worked hard to have jobs with health insurance, but health insurance should be provided for all. There are selfish reasons also that I want health insurance for all. I don't want to sit near someone on a bus, plane, or train who has a deadly contagious disease who isn't taking medication for the disease because he or she can't afford the meds or vaccinations.

@chippydoo

I do not understand why I have to "chew" on anything ????

First of all I stated that YES - there probably IS such thing as "over-treatment " (?!)

Second - perhaps try not to jump into conclusions about what I try to say in general ?

Thanks.