This one hits a lot of guys here who are diagnosed with pT3B after prostatectomy and are stuck on the what next. The overall survival benefit for adjuvant ADT is approximately 4 in 100 but once again we have a study that can be quite flawed. The center doing this work is the respected Mayo Clinics. It is a retrospective look at 191 men who were originally treated with RP between 1987 and 2002 and the median follow up is 10 years...From the Infolink:prostatecancerinfolink.net/2011/02/06/limited-value-of-immediate-adjuvant-adt-in-men-with-pt3b-prostate-cancer/
Overall survival of this 191 men cohort is as follows:
Adjuvant ADT 74% had survived to date
no Adjuvant ADT 69% had survived to date
Several things to keep in mind. First there is better therapies today. And once again we could see a significant change in 5 or ten years follow up. I know there are several follow up studies for adjuvant radiation versus adjuvant radiation with combination ADT that show much better benefits. The study does no give us the information about
other forms of therapy that were also applied. This is one reason that retrospective studies are not the best evidence. There are other trials out there that meet level 1 evidentiary criteria but we have to wait for them to complete and that will be years.
These results, while not encouraging, do indicate that there is survival benefit but it also brings into question whether there is enough benefit to counter the morbidities that come with ADT.
I am in this class of patient on year 4 after RP/ADT/RT. Over 31% of men in this class has died at the ten year mark after electing for whatever reason to bypass adjuvant HT. It's 26% on those who chose ADT. I believe that we are doing better that today than we were a decade ago.
At least I certainly hope so...
Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7
Da Vinci Surgery ~ 2/17/2007
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.
Post Edited (TC-LasVegas) : 2/7/2011 10:04:16 PM (GMT-7)