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CK + ADT: Current Thinking?
Ken M
Posted: Friday, November 23, 2018 2:54 PM
Joined: 11/23/2018
Posts: 4


I have read some prior journal articles, particularly those written by Dr Katz, showing that ADT adds little value to SBRT via CK. Is anyone aware of recent results that continue to confirm that conclusion?

I'm asking because I am now facing that decision (among others) for a newly discovered borderline Gleason 4+3 (40% of each, 20% neither) transition zone tumor. I don't want to subject myself to those nasty side effects, but I will consider it if a strong argument can be made that it improves the likelihood of a favorable outcome (e.g., probability of N-year bDFS for large N).

All replies will be most welcome.

Ken M



JAV
Posted: Saturday, November 24, 2018 6:28 AM
Joined: 10/29/2010
Posts: 801


Are you saying a "CK" radiation oncologist has recommended ADT prior to CK ? If so, I have never heard of that before, BTW. The first urologist I saw talked about ADT prior to traditional radiation. But after seeing him, after reading the AUA Clinician's Guide to Localized CaP , I found another urologist who never talked about ADT. Link to Clinician's Guide to Localized CAP : https://www.auanet.org/Documents/education/clinical-guidance/Clinically-Localized-Prostate-Cancer.pdf I believe the ADT injections are given by urologists. BTW, Dr. Katz is not the only RO on this Forum who doesn't recommend ADT. I'm certain I read Dr. Medberry isn't a fan of ADT either. Jim V.

Treated with CK 4-2011.  Gleason of 3+4 , PSA 3.7 , two cores positive, 5% & 12%
 PSA on 7-13 0.3  PSA on 11-13 0.3 PSA on 5-14   0.3  
PSA on 7-14   0.2 PSA on 11-14  0.2 PSA on 3-15 0.2
PSA on 7-15, 0.2 PSA on 7-17 0.1 PSA on 1-18 0.13
Ken M
Posted: Saturday, November 24, 2018 7:39 AM
Joined: 11/23/2018
Posts: 4


Jim,

 Thanks for your reply and for the link.

 It was a urologist who (during my only encounter with him, so far) suggested 4 to 6 months of ADT prior to starting CK. He also referred me to a radiation oncologist whom I’ll be meeting next week. I’m in the midst of doing my “homework” to prepare for that meeting. His opinion on ADT will be near the top of my list of questions. That’s also the reason that I am seeking input from this forum at this time.

 If there is any hard evidence that ADT improves CK outcomes, then I will consider that option. I haven’t found anything yet, although it has only been nine days since I started looking.

 

Ken M




radsrus
Posted: Saturday, November 24, 2018 7:47 AM
Joined: 10/10/2008
Posts: 4435


Both San Diego and ST Southwestern are reporting 100% control with CK. ADT cannot improve on that result. Even if you discount it to the 96% that Katz reported with low-risk patients, then it is highly unlikely that ADT will improve results. When you get to intermediate risk the results are not quite as good, but still pretty good. And there is no evidence that ADT adds to the results in SBRT-treated patients. Admittedly, a stronger argument could possibly be made, but still unconvincing. You did not mention your PSA but if it is >10 then you are in the high risk group. With standard radiation the results are improved with ADT in high-risk patients. There is not similar evidence with regard to SBRT-treated patients. Alan Katz has reported that his high risk patients do as well with CK and no ADT as conventionally treated patients with IMRT +ADT. I cannot make a strong intellectual argument against ADT in the high risk patients, but I personally would not take the ADT. Men feel really crappy on it in general.

Clinton A. Medbery, III, M.D. Southwest Radiation Oncology buddy@swrads.org
Chuckwalla
Posted: Saturday, November 24, 2018 7:50 AM
Joined: 11/24/2018
Posts: 3


Good day, I did meet with about 5 doctors, both urologists and oncologists to review my new diagnosis, Gleason 3+4=7; psa 6, T2b, MRI guided biopsy. Visited MDA and Mayo, all physicians agreed that I could pursue surgery or radiation. ADT was mentioned only by one Doctor in combination with radiation for 4 months. Finally I discussed with a oncologist doctor who administers hormone therapy and he felt it was not required. So I shall proceed with CK in California to overcome the cancer. I am 58 and optimistic about my outlook. No ADT at this time.
Chuckwalla
radsrus
Posted: Saturday, November 24, 2018 8:10 AM
Joined: 10/10/2008
Posts: 4435


Good plan

Clinton A. Medbery, III, M.D. Southwest Radiation Oncology buddy@swrads.org
Ken M
Posted: Saturday, November 24, 2018 8:11 AM
Joined: 11/23/2018
Posts: 4


Dr Medbery,

Thanks for your input.

My current status is: clinical stage = T1c, most recent (3 months ago) PSA = 5.3, Gleason Score = 4+3 (actually, borderline but close enough). So I am currently intermediate-risk, unfavorable.

The information you provided is very helpful and much appreciated.

Ken M

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Ken M
Posted: Saturday, November 24, 2018 8:16 AM
Joined: 11/23/2018
Posts: 4


Chuckwalla,

Thanks for sharing your experience. I find it interesting that the consensus of those who you consulted did not recommend ADT for you.

Ken M






 

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