Where can I find a study that shows long-term outcome of surgery or radiation with adt vs without?

When a man has locally advanced PC, it is pretty much assured that his doctors will want to put him on ADT before or after surgery or with radiation.

But I am very curious to know where I can find statistics that state what survival rates are for locally advanced PC guys that choose not to go with ADT and instead opt for radiation or surgery only??

It's not that I necessarily think that this would be a smart move. But how does one make a truly informed choice about ADT if these stats are not out there?

Peanut,
It would really help if you'd add a signature so I could tailor my response to your situation. There's lots of good info (although never enough!) but I need more info from you. What is his diagnosis - Gleason score, stage, and PSA? Also, it depends on what kind of radiation you're looking at.

ADT is not usually given before or after immediately surgery, except in a few clinical trials. Used beforehand, it may make reading the path report more difficult. Afterwards, it is only used along with adjuvant radiation in those cases that require it.

- Allen

OK- now I that I understand the situation, so I can point you in the right direction.

I'm not sure why he did early chemo without ADT with only two positive nodes (and negative bone scan, I assume), unless as part of a clinical trial. But let's take it from there. Lifelong ADT has been the traditional treatment after positive nodes were discovered. It was not given to cure the PC, but only to shrink the tumors and slow it down. Until recently, it was considered pointless to add radiation therapy in such cases.

There is new evidence that adding radiation to hormone therapy might be beneficial for node positive PC. Below is an article that discusses the studies that pertain to his situation:

ADT and radiation for first-line treatment of node-positive (N1) prostate cancer

But why not just give the radiation without the ADT? It has long been known that ADT improved the results of external beam treatment in high-risk men, but there was a lingering question as to whether that was still true with today's dose-escalated therapy. A recent clinical trial proved that it is still true:28 months of adjuvant ADT had significantly superior results compared to only 6 months in high risk men:

High-dose radiotherapy with short-term or long-term androgen deprivation in localised prostate cancer (DART01/05 GICOR): a randomised, controlled, phase 3 trial

You didn't mention the kind of radiation he is looking at, but combination therapy with a brachy boost to the prostate has proven superior to IMRT alone:

EBRT + LDRBT boost provides superior cancer control compared to EBRT alone[/list]

Nomar Shotzenkeister, an HW member, recently had SBRT therapy for exactly that situation, but such use is experimental.

I hope that provides the info you were looking for.

- Allen

CHAARTED has so far only shown a survival benefit in men diagnosed with multiple mets (5 or more) and it was used along with ADT. The purpose in CHAARTED was to increase survival duration rather than cure. ADT + radiation, on the other hand, has potential to be curative.

The DART 01/05 study compared longer-term ADT to shorter-term ADT and found a significant benefit. If longer works better than shorter, it certainly works better than none. I'm afraid you can't make a reasonable case for not using it with IMRT. The data are convincing.

You are understandably anticipating adverse outcomes on your relationship. However, it's not forever, it's for about 2 years. It shuts off his sex drive, not his need for intimacy. A lot of couples have problems dealing with this. If there's a local branch of the Cancer Support Community, nearby, they may provide couples support. There are also couples therapists who specialize in cancer patients - perhaps you can find one who can help you through this rough period.

- Allen