Headed For SRT--Any Advice?

As you can see from my profile, I have a recurrence underway almost three years after my RP, and will undoubtedly be undergoing SRT soon. I'm meeting with my urologist Thursday, and am expecting to be referred to a radiation oncologist and perhaps a medical oncologist also. The MSKCC nomogram for my numbers came in at 33% recurrence-free at 6 years with SRT and 59% with SRT+ADT. I would appreciate any input and/or advice generally, and in particular on the question of ADT or no ADT. I would really like to hear from those who have been or are currently in my situation, also any advice on what questions I should be asking in my meetings with the urologist and oncologists. I appreciate your help.

My numbers are similar to yours and I went with ADT based on advice from Roach at UCSF and also from Scholz. It's not too bad, and the baseline amount of 4 months is not too hard to take. I'm just starting the radiation part now, 7 weeks to go.

Yes, I do know why. It's because MSK uses the Stephenson nomogram. The nomogram is based on retrospective data rather than randomized clinical trial, and is statistically constrained by the data in the sample. In other words, for every nomogram prediction, there may be large variances in its predictive accuracy. Overall, the nomogram used here is accurate 69% of the time, but for your particular set of answers, the predictive accuracy may fall to not much more than a coin toss.

Stephenson said...
No prospective study has evaluated the impact of ADT in the salvage setting. ADT administered before and/or during SRT was associated with improved PSA control in our study, although this may potentially be explained by the effects of prolonged ADT (up to 24 months in some patients) on masking PSA recurrence.

He explains that because of this "Sixty-three patients (4%) received adjuvant ADT after SRT and were excluded from the analysis of PSA-defined end points." So only those patients who received neoadjuvant ADT were included in the nomogram (14% of total).

Predicting the Outcome of Salvage Radiation Therapy for Recurrent Prostate Cancer After Radical Prostatectomy

Among the decisions that fall on you is not just ADT vs no ADT; but also, if you have ADT, then for which periods and for how long - neoadjuvant? concurrent? adjuvant?

Also, they were treated with between 63-66 Gy of SRT, which most would now consider inadequate. To some extent, ADT substitutes for reduced dose.

I'm not at all saying that ADT with SRT is a bad idea for you. It's just not a "no brainer"and there is precious little quality data to inform your decision - it's very much a judgment call, with no clear right or wrong answer. It's all about your assessment or oncological risk and treatment side effects.

- Allen

I opted for ADT along with SRT. It seemed like a coin toss to me. The ADT has not been too hard. No interest in sex. about a 10% loss of strength. I have used weights for 40 years so I can calibrate strength quite well. Maybe some tiredness but hard to separate from radiation effects. The other parts of my life have been really good so that probably masks potential depressive effects.

Hey Phenom, remember me? Sorry to see you are having to go thru this again. I am almost in the same boat now. Any luck on making a decision?

At my last appointment with my urologist oncologist I asked him if and when the time comes that I might require SDT if I should include ADT. His reply was, no since I only have GS7 - only if someone has aggressive PCA which I take is short doubling time and GS 8, 9 or 10.

Look at it this way: even if you're not cured, you'll have killed off most cancer cells in your pelvic area, which will certainly slow down any future progression. But I think ADT is an important adjunct to SRT: makes it more effective from everything I've read. Get another opinion from a rad onc.
Bob