Better get that pelvic node RT - study results

"The international, Phase III clinical trial that served as the basis of The Lancet study, enrolled 1,716 patients between March 31, 2008, and March 30, 2015. Enrollees were separated into three groups.

Group one received salvage prostate bed radiotherapy -- a standard radiation targeted to the area in which the prostate used to exist before its surgical removal. These patients had a median five-year survival of 71%.

The second group received the standard radiation treatment, in combination with androgen deprivation therapy. They had a median five-year survival of 81%.

The third group received salvage prostate bed radiotherapy, androgen deprivation therapy and pelvic lymph node radiation. These patients had a five-year freedom from progression of just over 87%.

"The combined treatment approach proved to be the most beneficial approach," said Sandler, also the Ronald H. Bloom Family Chair in Cancer Therapeutics."

https://www.sciencedaily.com/releases/2022/05/220526125753.htm

Missed that I guess.....

Post-RP men who had a good number of nodes removed that were all negative AND a low-risk Decipher score done on RP tissue have support for fossa-only (rather than whole-pelvis) RT, especially if the BCR occurs a good number of years after surgery with a long doubling time.

Djin

My husband's MO explained that there's a synergistic effect of doing ADT in conjunction with RT. The ADT makes the RT more effective by messing up the DNA of the cancer cells, and interfering with the cancer cells' ability to reproduce. That's my memory of the words used anyway, and probably a simplified explanation on his part.

Mumbo said...


I also have a tentative theory that each person has a finite effective benefit of ART and that the earlier it is used, the less effective time remains before it eventually fails. Essentially, you help breed the cancer to not need hormones as it morphs along. I may be completely wrong about this but since you can’t kill the cancer 100% with ADT, you eventually make it stronger.

I'm thinking you meant to say ADT instead of ART at the top of the quote. If so, I fall into this camp too, based on the philosophies of the three MOs I've had. And at this stage, when curative treatments have failed, there is scant evidence that starting ADT early is better. MOs will be working with their beliefs and experiences in this area of treatment, without the benefit of SOC, as far as I know. I do understand the impulse of guys wanting to keep the cancer down before it has a chance to get "out of control." I think there can also sometimes be an unbearable discomfort for some guys knowing they have an increasing PSA. There can be the urge to "do something."

MOs no.1 and no. 2 were in favor of letting the PSA go to around 20 and then treating with ADT, but starting earlier if the doubling time was short or mets became detectable on bone or CT scans. (The newer sensitive scans are shaking this definition up, though).

MO no.3 was fine with the plan until my PSA took a big jump and said it was time to move. I might have pushed the ADT delay a little too much, but so far, so good.

OP, sorry for going OT.

Mumbo, if your quote was what you intended, nevermind. 😁

Mumbo and Mattam,

I have been concerned that using ADT for a longer period right now (with salvage radiation) might impact its effectiveness later on, or shorten the time the ADT would continue to suppress the cancer later on if my husband should need to take ADT later.

I believe I have asked every doctor about this and each one has said that there's no risk. But then they usually follow up with something that indicates that there's still so much that's unknown.

Of course I'm hoping that taking ADT for a year or two now (instead of four or six months) will have no negative effects later on.

There really is so much that isn't known.

M

Yes, Duck2. An MO at Sloan Kettering did say that--that ADT can kill micromets wherever they are in the body. Interestingly the MO at UCSF did not say that specifically but hoping it's true!