New study 18 vs. 36 months HT

Southern Comfort,

I have a call into my RO (per this article) & will meet with my URO on 3-8-13. I want to get off HT as soon as possible so if they both agree I AM DONE!!!!!

Dave

Another source, and I am all for saving money, saving patients from nasty side effects and bone density or memory losses too. Also, like seeing cash cow syndrome getting cured.

 http://prostatecancerinfolink.net/2013/02/13/18-months-of-adt-as-good-as-3-years-when-combined-with-radiation/

Never any controversies in this stuff, ever (LOL)

Interesting news....last time I went to my Rad. Onc and Uro...they both knew I was a little hesitant to keep on with the HT....They both came in armed with articles and facts about how 3 yrs of HT is better than Intermittent.

Thanks for the links and I printed them both off.....next time in march...Im gonna be the one whipping out the paperwork!  Wouldnt surprise me these 2 clowns are pushing the stuff for their pocketbooks.

Gunfighter,

Need to reread the study....

The 10-year prostate cancer-specific survival rates were

• 87.2 percent for men in Arm 1
• 87.2 percent for men in Arm 2

Dave

Does that study only include men who had primary RT (with a prostate) and ADT? Or did it include SRT/ADT patients as well? I suspect the former.

I believe that adjunct HT can make SRT look much better than it really is...I stuck out the HT for 14 months, PSA undetectable...But 3 months after I stopped the HT, PSA jumped to 0.8 I'm back on HT for the duration now..Next PSA test in a few weeks...But hey, G-9's, we play in a different ball park than most.....

Mel,

Your context is different than that of the study. The 18 vs 36 month study addresses ADT given along with radiation for first line therapy with curative intent. The same goes for the Bolla study of 36 mo vs 6 mo, along with radiation.

For you, with a BCR, I think the relevant studies are continuous versus intermittent ADT. Dr. Lam appears to have intermittent ADT planned for you. For intermittent, I think most doctors plan for a shorter on-cycle.

SC

Dr Lam has me scheduled for HT for 12 months. I knew this was on the shorter side and I asked if there was a chance that he might extend it. He said "no" and that there was no data to support going longer than that in my case.

In fact, he initially mused about doing it for 6 months, but he and Dr. Scholz consulted and concurred that 12 months was right.

Michael

I just had a six month Lupron last month and another three month shot planned in July to complete my 36 month regime per the Bolla study. Certainly before the July shot I will discuss this with my oncologist, urologist and radiation oncologist.

While it looks like I fit their description of "high risk localized" I do not recall the specifics of my radiation. In addition to the prostate area, I received radiation to the pelvic lymph nodes, but don't know whether it met the specific standard of "70gy to the prostate area over 7 weeks and 40gy to the whole pelvis over 4.5 weeks". Since I had adjuvant HDR brachytherapy, my IMRT gy dose was less than 70, I think more like 45gy in 25 fractions. My HDR was about 45gy in two procedures. I don't recall the gy dose to the pelvis and whether it was the whole pelvis.

As with so many studies, this is very specific and , I surmise, requires one to follow the protocal used. So, if I didn't get the same level of pelvic radiation, then I would not assume that 18 months on ADT would have been wise. On my first read, I don't see that this conflicts with or takes the place of the Bolla study, but it does give better direction to high risk localized treatment combining radiation and ADT. Great information.

FoxRun: It certainly isn't my preference to extend my HT. Rather, I was worried about Dr Lam extending it given that 12 months is on the short end (as per this thread). Plus, he initially told me six months and then the decision was made to move it to 12 months...I was worried that there might be another "extension" in my future. (And yes, I'll be happy when it's over.)

BTW, I notice our stats are somewhat similar, as our treatment choices.

I wonder what the difference would have been with a group with RT only, no ADT at all. I suspect the numbers may not be much different, maybe a 5-10 percent improvement with ADT. So the difference in 18 vs 36 months may be small compared with the curative or delaying action of the RT to begin with. Could be that at 15 years we may begin seeing more of a difference. The positive message from this, in my mind, is that even in high risk cases the PC specific death rate is pretty low even after 10 years.

Southern Comfort said...
reachout,

That was study was done .. radiation-only vs. radiation + 3 yrs ADT. It was a significant difference in favor of ADT.

http://www.nejm.org/doi/full/10.1056/NEJM199707313370502

<span style="WIDOWS: 2; TEXT-TRANSFORM: none; BACKGROUND-COLOR: rgb(255,255,255); TEXT-INDENT: 0px; DISPLAY: inline !important; FONT: 13px/18px arial, sans-serif; WHITE-SPACE: normal; ORPHANS: 2; FLOAT: none; LETTER-SPACING: normal; COLOR: rgb(51,51,51); WORD-SPACING: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px">Results: Data were available for analysis on 401 patients. The median follow-up was 45 months. Kaplan–Meier estimates of overall survival at five years were 79 percent (95 percent confidence interval, 72 to 86 percent) in the combined-treatment group and 62 percent (95 percent confidence interval, 52 to 72 percent) in the radiotherapy group (P = 0.001). The proportion of surviving patients who were free of disease at five years was 85 percent (95 percent confidence interval, 78 to 92 percent) in the combined-treatment group and 48 percent (95 percent confidence interval, 38 to 58 percent) in the radiotherapy group (P<0.001).

<span style="WIDOWS: 2; TEXT-TRANSFORM: none; BACKGROUND-COLOR: rgb(255,255,255); TEXT-INDENT: 0px; DISPLAY: inline !important; FONT: 13px/18px arial, sans-serif; WHITE-SPACE: normal; ORPHANS: 2; FLOAT: none; LETTER-SPACING: normal; COLOR: rgb(51,51,51); WORD-SPACING: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px">Another study was done comparing radiation + 3 yrs ADT vs. radation + 6 months ADT to see if a shorter duration of ADT could work. Six months provided inferior survival to 36 months of ADT.

<span style="WIDOWS: 2; TEXT-TRANSFORM: none; BACKGROUND-COLOR: rgb(255,255,255); TEXT-INDENT: 0px; DISPLAY: inline !important; FONT: 13px/18px arial, sans-serif; WHITE-SPACE: normal; ORPHANS: 2; FLOAT: none; LETTER-SPACING: normal; COLOR: rgb(51,51,51); WORD-SPACING: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px">http://www.nejm.org/doi/full/10.1056/NEJMoa0810095

<span style="WIDOWS: 2; TEXT-TRANSFORM: none; BACKGROUND-COLOR: rgb(255,255,255); TEXT-INDENT: 0px; DISPLAY: inline !important; FONT: 13px/18px arial, sans-serif; WHITE-SPACE: normal; ORPHANS: 2; FLOAT: none; LETTER-SPACING: normal; COLOR: rgb(51,51,51); WORD-SPACING: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px"><span style="WIDOWS: 2; TEXT-TRANSFORM: none; BACKGROUND-COLOR: rgb(255,255,255); TEXT-INDENT: 0px; DISPLAY: inline !important; FONT: 13px/18px arial, sans-serif; WHITE-SPACE: normal; ORPHANS: 2; FLOAT: none; LETTER-SPACING: normal; COLOR: rgb(51,51,51); WORD-SPACING: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px">Results: A total of 1113 men were registered, of whom 970 were randomly assigned, 483 to short-term suppression and 487 to long-term suppression. After a median follow-up of 6.4 years, 132 patients in the short-term group and 98 in the long-term group had died; the number of deaths due to prostate cancer was 47 in the short-term group and 29 in the long-term group. The 5-year overall mortality for short-term and long-term suppression was 19.0% and 15.2%, respectively; the observed hazard ratio was 1.42 (upper 95.71% confidence limit, 1.79; P=0.65 for noninferiority). Adverse events in both groups included fatigue, diminished sexual function, and hot flushes.

<span style="WIDOWS: 2; TEXT-TRANSFORM: none; BACKGROUND-COLOR: rgb(255,255,255); TEXT-INDENT: 0px; DISPLAY: inline !important; FONT: 13px/18px arial, sans-serif; WHITE-SPACE: normal; ORPHANS: 2; FLOAT: none; LETTER-SPACING: normal; COLOR: rgb(51,51,51); WORD-SPACING: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px">The latest study may be the first one to show that 18 months is equivalent to 36 months.

A lot has changed, in the radiotherapy field, since 1987-1995

The report said...
METHODS
From 1987 to 1995, 415 patients with locally advanced prostate cancer were randomly assigned to receive radiotherapy alone or radiotherapy plus immediate treatment with goserelin.