Combining ADT with Adjuvant Radiation Threrapy

Sounds like your surgery has failed and salvage radiation is next. The answer to your question is yes, adding ADT will increase your chances for a cure by 50%..At least that's what several studies have shown..

Peter, Thanks

I found this information at the AUA website -

Per that group: Overall, the Panel's conclusion was that, in the absence of randomized trials, the role of ADT in the ART or SRT context remains unclear.

Sort of you are darned if you do and darned if you don't====

http://www.auanet.org/education/guidelines/radiation-after-prostatectomy.cfm

ADT in the adjuvant setting. Only five observational studies compared RP patients who received adjuvant radiotherapy to those who received ART in combination with some form of ADT.35, 54, 55, 57, 172 Although all four studies reported findings suggesting that patients who received ADT in combination with ART had better outcomes, only one study reported a statistically significant difference between groups. Specifically, Bastide35 reported at median follow-up 60.3 months that the ART+ADT group had significantly higher biochemical recurrence-free survival (bRFS) rates at five and seven years than did the ART only group (82.8% vs. 44.4%, respectively, at 5 years; 62.1% vs. 28.6%, respectively, at 7 years). bRFS rates for two additional comparison groups (patients who had RP only and patients who had RP+ADT but did not have ART) were similar to rates for the ART only group. All patients in this study had SVI but the distribution of other risk factors (i.e., Gleason scores, positive margins) differed somewhat across groups. The ADT administered was an LHRH analog; it was initiated on the first day of RT with median duration 12 months. These findings require replication in a randomized trial such as the ongoing RADICALS trial. Ost172 did not detect a difference in bRFS at seven years (ART only – 86%; ART + ADT – 79%) or clinical RFS (ART only – 90%; ART + ADT – 83%) on univariate analysis but on multivariate analysis the use of ADT resulted in a significant hazard ratio of 0.4 for bRFS and 0.1 for cRFS. However, the two groups exhibited significant imbalances in pathologic risk factors, emphasizing the need for appropriately stratified randomized studies. Additional information is provided by DaPozza173 which reported that ART+ADT significantly improved bRFS and cancer-specific survival on multivariate analyses (but not univariate analysis) compared to patients who received ADT only (all patients in this study had positive nodes); however, there was no ART only comparison group in this study.

ADT in the salvage setting. Twenty-three observational studies evaluated RP patients who received salvage RT compared to those who received SRT in combination with some form of ADT. Overall, this literature arrived at mixed conclusions. Seven studies documented statistically significantly better outcomes for SRT+ADT patients compared to SRT only patients.57, 63, 91, 99, 109, 145, 147 Findings from the study with the largest sample size147 (1325 SRT patients; 214 SRT+ADT patients) derived from a multi-institutional retrospective cohort were used to develop an SRT nomogram and demonstrated a significant advantage in progression-free survival for patients who had SRT+ADT compared to SRT only patients. ADT (type not specified) was administered either before RT or during RT for median 4.1 months.

Eight studies reported that SRT+ADT patients had better outcomes than SRT only patients but either did not report a p level or the comparison did not reach statistical significance.32, 55, 74, 92, 105, 115, 124, 144 In one study, although the overall comparison was not significant, a significant advantage in progression-free survival was observed in high-risk patients (defined as pT3 or higher, Gleason score 8 to 10, or PSA of 20 ng/ml or higher at RP).144 Eight studies indicated that SRT only patients had better outcomes than did SRT+ADT patients or that the outcomes were indistinguishable.75, 82, 94, 127, 129, 142, 146, 162

Although the majority of studies suggested better outcomes for patients who had SRT in combination with some type of ADT, studies differed in when ADT was administered (pre-RT only, pre- and during RT, post-RT only; during RT only; during and post-RT), for how long (weeks, months, years) and in ADT type. In addition, studies varied in patient risk factors, RT protocols and follow-up durations. Overall, the Panel's conclusion was that, in the absence of randomized trials, the role of ADT in the ART or SRT context remains unclear.

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Allen -


You are probably correct - However, since adjuvant RT generally starts when the PSA is lower than when salvage begins, it may not make that much of a difference?

I know starting RT at a lower PSA makes a difference --

AUA's opinion--
"Overall, the Panel's conclusion was that, in the absence of randomized trials, the role of ADT in the ART or SRT context remains unclear."

In my case, I would like to avoid ADT if it doesn't make a big difference and without larger randomized trials ???

I meet with U of Miami RO, Alan Pollack, on Tuesday - I'll have my first post RP PSA then too.

Bobby Mac

To the point...take no prisoners...no stop and chat there...