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Immediate ADT offers little OS benefit for PSA-detected PC relapse

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Posted 5/15/2014 7:55 PM (GMT 0)

The following findings suggest the decision to defer initiation of ADT until clinical progression or at least 2 years after PSA relapse may be a safe approach that could considerably reduce costs...certainly not saying this would be the path I would go if other evidence of disease was found (scans, etc...)...but looks like a valid option for PSA rise only PC.

http://www.healio.com/hematology-oncology/prostate-cancer/news/online/%7B0b1602cb-2f7d-4bb6-8b9c-2566b49580a7%7D/immediate-adt-offers-little-os-benefit-for-psa-detected-prostate-cancer-relapse

 

Posted 5/16/2014 12:32 AM (GMT 0)
okay i'll go first. I don't agree but I'm sure it saves money and that'll make someone happy cool

ed
Posted 5/16/2014 2:36 AM (GMT 0)
Jerry L,
The more I read it seems the less that I know. I am becoming rather "jaded" or as a minimum confused with the numerous contradictory trials/studies/papers and observations that I've read.
I'm with Ed on this one!
Bill idea
Posted 5/16/2014 3:01 AM (GMT 0)
The perspectives from Hudis and Yu are excellent. I agree with Hudis that this now needs to be a defined clinical trial. Unfortunately the CAPsure database is full of variables. Randomization will be the only way to confirm this.
Posted 5/16/2014 3:33 AM (GMT 0)
Gee, what do you know, an article that backs up and supports my oncologist's view and our combined "plan" the past 3 years. Some here made it sound like I was on a wrong path.

Part of the article says, and I quote:

"The decision to defer ADT could improve patients’ quality of life by avoiding or delaying the common treatment-related adverse effects, such as osteoporosis and risk for bone fracture, sexual dysfunction, hot flashes, decreased mental sharpness, fatigue, loss of muscle mass, increased cholesterol, weight gain and depression."

Exactly what my doctor feels in my case. Yes, mine right now is a PSA case, and no evidence of visible mets, and since I already have a terrible QOL going on, my oncologist who already doesn't agree with early HT use after failed surgery/radiation patients like myself, has been trying to spare me all of the above side effects and additional QOL issues.

David
Posted 5/16/2014 4:28 AM (GMT 0)
Hi David,
This is a hypothesis but it isn't new. There are positions and papers on both sides of this. What I found interesting were the views of Hudis, the current ASCO President, and Yu the President Elect for ASCO. If this can be proven true then it can be beneficial to most men. But I have a feeling, that genetically, there will be subsets of men that respond better to earlier HT and a subsets of men that respond better later with HT.

Until that trial it's not going to be answered.
Posted 5/16/2014 4:48 AM (GMT 0)
yes David vindication cool

ed
Posted 5/16/2014 1:49 PM (GMT 0)
Tony, I agree with your conclusion, there are men who absolutely can benefit from early HT, and there are those, that delaying it, will not put them at any additional risk. No problem with that. But it does show that a doctor with views like mine has, is not being reckless with a patient like me with a case like mine.

David

Especially when such patient is already dealing with severe QOL issues without the HT being added to it. He and I both know, the day is coming, that even the QOL part won't matter as much - when he feels that its time to pull some kind of advanced treatment on me, and when that time comes, I will have to bite the bullet, whether it be HT or Chemo. I know that, my doctor knows that, until that time, we will continue to stay the present course.
Posted 5/16/2014 4:39 PM (GMT 0)
I noticed that the study excluded men if they received secondary treatment such as salvage radiation. That probably includes a lot of us on the HW site. RalphV also posted a contradictory study in an old HW thread:

"In a randomized study by the U.K. Medical Research Council Prostate Cancer Working Party Investigators Group, results demonstrated a 32% survival benefit with early hormonal suppression over delayed suppression, and at the same time pathological fracture, spinal cord compression, ureteric obstruction and development of extra-skeletal metastases were twice as common in deferred patients. Improving quality of life is thus an important issue in applying hormonal suppression at an early stage of advanced disease."

My oncologist believes early may be better that later in my case and I'm happy with that.

Carlos
Posted 5/16/2014 6:12 PM (GMT 0)
Carlos,
The study also eliminates any adjuvant or neo-adjuvant therapy cases. The earliest forms of HT or combinations of RP, HT, RT, etc. An area that a Level 1 set of trials has shown life extending benefits and better disease controls in certain patient subsets. It simply covers men that had RP and had a rising PSA afterwards. It does not even state if any of these men achieved a remission (undetectable PSA). It merely a retrospective view of data in the CaPTURE database and it would likely not deliver the same statistical values in a randomized clinical trial.

But it does need to be looked at in such a trial.
Posted 5/16/2014 7:58 PM (GMT 0)
He who pays for the study very often gets the results he was hoping for...
Posted 5/16/2014 10:10 PM (GMT 0)
He who pays for the study very often gets the results he was hoping for...

cool

there's a movement under foot I tell you, and messengers speaking with forked tongue cool .

ed
Posted 5/16/2014 11:49 PM (GMT 0)
Funny I just had a 22.5 mg lupron shot pre SRT the day before this came out. It hasn't changed my opinion unless I develop awful SE's at which point I wouldn't get another shot. So far no SE's. My RO felt it could help make the SRT more effective so I said let's try it. No harm no foul hopefully! Gl9 pt3b with PSA rising to .3 eight months post op. 4 month psadt. He and my uro both think the PCa is still in prostate bed near positive margin due to slow rise in PSA. Hope they're right!!!
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