Not all research is alike. In research terminology, there are "levels of evidence." Level 1 evidence - which means large randomized clinical trials - are the only ones that prove
anything. "Proof" means this - now we know what is likely to happen is they use treatment X vs. if they don't use it. When we learn something that is Level 1 evidence, it can be practice changing. The Duchesne study was level 1 evidence.
The Duchesne study found that, among men whose curative options have been exhausted, 11% died within 5 years if they started ADT immediately, but 20% died within 5-years if ADT was delayed - the death rate nearly doubled if ADT was delayed.
This confirms an earlier randomized clinical trial where patients were follow-up for a much longer time (14.6 years) among men with locally advanced prostate cancer. Among those who received bicalutamide immediately, the death rate was 23% lower compared to those who only received standard of care.www.ejcancer.com/article/S0959-8049(15)00288-9/abstract
In the studies you cited, The Schroeder study is not really relevant. It was among men diagnosed with LN mets who had never received any treatment. The study was underpowered, which means the statistical significance doesn't prove or disprove their hypothesis. Even so, early treatment reduced the hazard of death by 22%, and survival was 1.5 years longer if they started early treatment.
The Studer study has nothing to do with this issue, it just says that the time to death is faster when the PSA is higher or doubling quickly (not very surprising). The Wong study was just a database analysis (level 3 evidence - which should only be used to suggest further studies) among men who were lymph node positive after RP. Read what they wrote: "Because observational studies should be considered hypothesis-generating studies, these results should be validated in a prospective fashion in a similar patient population."
Now, I went to the trouble of explaining all this because I think it is perilous to make claims not supported by evidence, especially where there is high quality (Level 1) evidence.
As far as zapping distant mets is concerned, there is no Level 1 evidence to support it, but the data are increasingly showing it is an ineffective approach. You are misinterpreting is what Ost is actually saying. He is right that there is a prolonged "progression-free interval" of about
3 years when men were detected to have 3 or fewer mets utilizing advanced detection techniques. Because all of the men had the SBRT, and none didn't, he can't say that the treatment caused
any delay. In fact, what likely caused the delay was what is called "lead time bias." Lead time bias occurs when men are screened with advanced techniques early in their progression. So the time to progression, which we know is slow at first anyway, only seems
to be longer; in fact, it was only detected earlier.
I have nothing against patients doing this when it is safe. I do
understand the feelings of desperation, and the need to feel that one is actually doing
something. I only care when patients put off starting ADT - which has level 1 evidence that starting it earlier has a real survival advantage.
However, if you want to ignore evidence and go with your hunches -- I truly hope it works for you. You have no way of ever knowing if it worked, or if it would have been just the same without treatment. But I can see you are hoping it will do something, and I hope so too.