Everyone kind of thought that at least short-term ADT may be a good idea for men who needed salvage radiation after a prostatectomy. Now we know
it's a good idea. You can read about
the French randomized clinical trial just presented at the ASCO meeting:Combining ADT and salvage radiation therapy improves outcomes
There are still many
• Is it beneficial when radiation doses above 70 Gy are used, or with hypofractionated sRT?
Is it beneficial when started sooner?
• What are the effects of adding ADT on long-term sexual function?
• Are there subsets of patients who are more likely to benefit than others?
• Are there biochemical markers (e.g., Decipher™ or CellSearch™) that may be used to identify patients more likely to benefit?
• Should ADT be started neoadjuvantly (before sRT)? Should ADT be used concurrently and adjuvantly?
• Is the optimum duration of ADT use related to the patient’s pathological findings – pre-treatment PSA, Gleason score, stage, and positive margins?
• Would outcomes improve with the expansion of the treatment field to include pelvic lymph nodes, and in which patients?
• Would outcomes improve through the detection and boosted treatment of metastases identified using multiparametric MRIs or PET scans?
• Would immune enhancement (e.g., Provenge, Leukine, Yervoy, Keytruda) improve outcomes?
• Would outcomes improve still further with adjuvant docetaxel, as demonstrated recently by RTOG 0621?
• Would stronger forms of androgen deprivation (e.g., Zytiga or Xtandi) improve outcomes?
Lots of issues to discuss with one's radiation oncologist.