RT + 3 years ADT + 2 years Zytiga initial treatment?

Posted by akiwi @akiwi, Sep 22 3:55am

Is anyone here being treated for non-metastatic disease with 3 years ADT + 2 years abiraterone (e.g. Zytiga) as a first Hormone treatment?
I'd be interested in hearing your experiences or what was communicated by your oncologists.

I as wondering because the European guidelines on PCa suggest this as a treatment.

"Offer IMRT/VMAT plus IGRT to the prostate in combination with long-term ADT and two years of abiraterone to cN0M0 patients with ≥ 2 high-risk factors (cT3-4, Gleason ≥ 8 or PSA ≥ 40 ng/mL)".
I was diagnosed with T3b GS 4+4, intra-ductal cribriform, cN0M0, PET PSMA negative, PSA 10.3 and have been treated with EBRT (whole pelvic + prostate/SV boost completed 24 July 2024) and Orgovyx.

So I was wondering if this has made it into clinical practice in other places?

I asked my RO (who knew about the trial results) about this but he thinks the benefits were not enough to justify the side effects. I should have been asked to decide ☹️, more likely it is not part of their standard of care yet.

Interestingly none of the hospitals that I got opinions from (of the four I consulted 😉) suggested this, but at one hospital the RO was one of the authors of those guidelines.

Any other thoughts about it that may be relevant (please don't hesitate about opinions - I'm capable of making up my own mind and will check everything).
You can always direct message me as well.

These are my Chatgpt discussions this morning and again I will check it carefully, (Chatgpt is often wrong or misleading).
https://chatgpt.com/share/66efd872-9b34-8013-b283-e7efc24ad238
p.s. The European guidelines are meant for Doctors but are very useful for patients as well with a bit of effort.
There are two versions, the full version and a pocket version (with just recommendations). I could not find a publicly accessible US equivalent but if anyone knows one I would be interested.
https://uroweb.org/guidelines/prostate-cancer
pocket: https://d56bochluxqnz.cloudfront.net/documents/pocket-guidelines/EAU-EANM-ESTRO-ESUR-ISUP-SIOG-Pocket-on-Prostate-Cancer-2024_2024-04-16-125527_rzmb.pdf

"Pocket" Version Page 102 (recommendation)
"Pocket" Version Page 112 (decision tree)

An article based on the Stampede trial
https://www.nejm.org/doi/full/10.1056/NEJMoa1702900

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

northoftheborder | @northoftheborder | Sep 23 1:35pm

In reply to @billfarm "My idea was to slam dunk and be done. Maybe too simplistic." + (show)

It is an open debate right now, but my impression (as a patient, not a practitioner) is that the consensus for stage 4 castrate-sensitive prostate cancer is still to start with radiation if there are few-enough metastases that you can target each one ("oligometastatic"), or perhaps consider chemo if there are too many. Either of those will be combined with ADT and probably some kind of ARSI for a triple attack. There are many more treatments to fall back on later, if the cancer wakes up again.