Tall Allen said...
This question only applies to guys in the intermediate risk category. Patients at low risk definitely do not need to begin with ADT (unless they have huge honking prostates and nevertheless desperately want to have seeds). Patients at high risk almost certainly should have ADT (and EBRT too).
What the researchers found in this data analysis was that it depends on whether you're "favorable intermediate risk" (who don't benefit from ADT) or "unfavorable intermediate risk" (who do benefit from ADT). For the unfavorable group, they didn't find any extra benefit for adding just EBRT over adding just ADT, but in light of the recent ASCENDE-RT trial results, a randomized controlled trial, I'd be reluctant to write-off the EBRT without better quality evidence.
This applies only to LDR brachy (seeds) and not to HDR brachy (temporary implants). ADT has not been found to be beneficial with HDR brachy in any risk group.
Here's an article about the study:
Optimal brachytherapy pre-treatment for intermediate-risk patients depends on “favorable” or “unfavorable” status
So it all boils down to favorable vs unfavorable condition and of course that other factor, let's not take any chances here and do whatever it takes to increase the odds in winning this battle.
Favorable Intermediate Risk: NCCN intermediate risk, as defined above, but only those with
Predominant Gleason grade 3 (i.e., Gleason score 3 + 4 = 7), and
Percentage of positive biopsy cores < 50 percent, and
No more than one NCCN intermediate risk factor
Unfavorable Intermediate Risk: NCCN intermediate risk, as defined above, plus
Predominant Gleason grade 4 (i.e., Gleason score 4 + 3 = 7), or
Percentage of positive biopsy cores ≥ 50 percent, or
Multiple NCCN intermediate-risk factors
DX in May 2011, Age 52, Stage T2c, GG 8-10, PSA=10.6 no symptoms.
CT & BS neg, high risk disease EBR + Brachy Seed Implants + HT
50mg of Bicalutamide first 30 days, 22.5 mg Lupron for 12 months
Nov 2011, undetectable
Feb 2012, undetectable T=1.66, Nov 2012 - 0.29 T=4.0
May 2013, 0.32 T=5.11, Nov 2013 - 0.20 T = normal
May 2014 0.22, Nov 2014 - 0.60