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Use of ADT with high dose EBRT

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Posted 3/13/2015 12:07 AM (GMT 0)
The writer of the article had verbal diarrhea, but luckily I read the whole thing, so I can give you the top-line summary:

• Long-term ADT improves outcome of escalated-dose EBRT for high risk PC
• Optimal duration of ADT is somewhere between 6 months and 18 months for high risk
• Short-term ADT (6 months) improves outcome of escalated-dose EBRT for intermediate risk PC.
• That benefit may be limited to unfavorable intermediate risk PC.
• The sequencing of ADT -before/during/after RT - may not matter all that much.

If you insist on reading it all for yourself, here's the link:

Androgen deprivation therapy and escalated dosing in radiation therapy

- Allen
Posted 3/13/2015 2:06 AM (GMT 0)
I'll take your word for what it says...
Posted 3/13/2015 2:19 AM (GMT 0)
Allen - is there any reason given in the article or elsewhere why to endure 7-9 weeks of EBRT when the same thing can be accomplished in 5 fractions with SBRT?

Only thing I can think of is not wanting to travel to Dr. Chris King at UCLA or Dr. Allen Katz in NY or group of doctors doing high Gleason Radiaiton in Toronto, only 3 I know of doing high Gleason SBRT.

Seems the escalating dosing can be done with SBRT just as readily as with EBRT.

LupronJim
Posted 3/13/2015 2:25 AM (GMT 0)
Andrew, you are a trusting soul.
Posted 3/13/2015 2:34 AM (GMT 0)
Jim,

The author does ask the following questions that he would like to see answered:

The author said...


• What is the optimal duration of ADT? We know from an earlier randomized clinical trial (Nabid et al., 2013) that 18 months of adjuvant ADT is as good as 36 months, even with lower-dose RT. So the optimal duration is somewhere between 6 months and 18 months.

• Is IMRT with a brachytherapy boost preferable, and is that enhanced by ADT? (I will address this in a separate article soon.)

• Is SBRT monotherapy preferable, with or without adjuvant ADT? (This was discussed in another recent article.)

• What is the effect on erectile function?

• Should the pelvic lymph nodes be treated as well? This is the subject of an ongoing clinical trial.

- Allen
Posted 3/13/2015 3:54 AM (GMT 0)

Tall Allen said...
Andrew, you are a trusting soul.

on my planet all the coins are stamped, "In Allen we trust."
smilewinkgrin
Posted 3/13/2015 5:50 AM (GMT 0)
Andrew and Allen..ditto. For the other mods too. They are more knowledgeable than most doc's, I wager. How about change the disclaimer..."not a medical professional, didn't even play one on t.v., but if you want advice about anything PCa, you've come to the source!"
Posted 3/13/2015 2:24 PM (GMT 0)
Allen,

I had appts. with my MO and RO yesterday. ( still in the zero club by the way) . My RO is a proponent of 2 year ADT after EBRT. I have a year to go. We talked about this study and he felt that the over all survival rate was impressive and a very good reason to do the long term ADT. We had been discussing length of ADT time off and on and he kept pushing the long term. This study has finally convinced me to do the full length. My MO who said 6 months was probably long enough even changed his tune and is ok with the full 2 years. Sorry for the rambling, probably didn't add much, but it help settle my angst some. My ADT has been very tolerable.

Carl
Posted 3/13/2015 4:07 PM (GMT 0)
As very high risk, I have been on a planned 3 year tour with ADT2. My next MO visit is just over a week away, and I'm definitely going to drive for cutting this off at 2 years (May 1). In fact, at this point I'm already at 22 months, so maybe that's enough! Maybe no more Lupron shots, no more ADT2. The side effect load is getting worse (fatigue, bone density loss), so maybe the remaining benefit is not worth the side effects?

Jerry
Posted 3/13/2015 4:22 PM (GMT 0)
Carl, I think the key part of your post is that you said ADT is tolerable. For a lot of guys it's not. (In retrospect I think mine was tolerable, but I'm not sure what I thought at the time.) As long as it is, that gives you some freedom to go for a longer duration.
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