10 year results of RADAR trial on ADT

Reachout, we have similar stats, are you looking into seeing a RO and MO?
What is your plans please as I am trying to figure out what to do? I will call tomorrow to make appointments with both.

Thanks reachout but aren’t you interested in getting
a PET scan.
And see If your pelvic lymph nodes haven't been treated and they are positive on the PET scan, you can have salvage radiation there. (with adjuvant ADT)?
This is what tall Allen has suggested to me

So far I haven't gotten any answers to my questions, so I'm thinking all they have published so far is this abstract but are keeping the rest of the data until they publish a paper. Tall Allen, can you give me any insights here?

jmadrid yes that helps. So at 7.4 years they had 4.1% to 7.8% prostate specific mortality depending on what group they were assigned to. They also had 13.9% to 19.4% overall mortality.

I think I see where I misinterpreted one of their findings. I thought they found no difference between prostate cancer specific mortality and overall mortality. Now I see that what they are saying is that they found "no change in ... all-cause mortality between the two groups." That is, the overall mortality was higher than prostate cancer specific mortality, but there was no difference in overall mortality depending on whether they used 6 months or 18 months of ADT. I guess. I hope the Tall One will let me know if I still didn't get this right.

Anyway, my interest in this study was not so much the difference between 6 and 18 months of ADT (although that is very interesting and the main point of the study), but the survivability of men on ADT after 10 years. At 7.4 years it was about 94% which are very good stats especially for the mean chosen that had locally advanced prostate cancer. I wonder though if this was the knee of the curve and the mortality rates increased a lot between 7.4 and 10 years. I am also still wondering if the overall mortality was related to ADT use or if the mortality rates were consistent with what would be observed in a cohort of men of the same age and overall health. Of course, since PC specific mortality is a subset of overall mortality, I would expect the overall to be higher than in a non cancer cohort but hopefully not significantly higher.

OK I will stop now, my head hurts.

Tall Allen said...
reachout-

That study was among men getting primary radiation therapy with adjuvant ADT for intermediate or high risk PC. What relevance do you think it has for you?

Fair question. It does not apply directly, or may not apply at all, as far as how long ADT was used for, or the prostate cancer specific survivability.

I am more interested in what they observed as the differences between the prostate cancer specific and overall survivability of the men in the study, regardless of how long they were on ADT. As you know, I am contemplating beginning ADT at some point in the future. If this study finds that men are surviving prostate cancer but are disproportionally dying of heart attacks, diabetes, or some other side effect of ADT, I think that would have some relevance to my choice as to when to begin ADT.

I'm sure the study will not address that directly. But maybe they would have statistics on, for example, the average age of men in the study and the number that survived for 10 years. If their overall survivability, after adjusting for prostate cancer deaths was, say, twice as high as we would expect for men that age, don't you think that might raise some questions about whether ADT was in itself increasing PC survivability but lowering overall survivability? Do you know of studies that have specifically looked at that question?

The relationship between pc-specific survival and overall survival is much more complicated than you imagine, and your wanting to ascribe more deaths to 18 months of adjuvant ADT (vs 6 months) is completely inappropriate. There is no evidence for your inference that ADT causes diabetes or CV disease. Those and other comorbidities increase with age, as does incidence of PC. In most RT studies, the median age is about 70. There are no valid conclusions for you to draw from this that is relevant to your case.

You are making a fallacious assumption that quality of life is better if you wait.

Overall survival with advanced PC is a complex issue - the patient often dies of something else that goes from sublethal to lethal due to the debilitating accumulation of cancer in his body. For example, diabetes or CV disease that might not ordinarily kill you may become the cause of your death when your body is full of cancerous tissue.

If you are old and frail, any therapy is more debilitating. You should only base such decisions based on physiological age - not chronological age. One man of 92 in my support group happily pops his 50 mg Casodex pill everyday and is in great spirits and remains happy and healthy. i strongly recommend trying it before you knock it. Fear is not a good stance from which to make a decision - personal knowledge is much better.

All the best with your procedure, Gary.