Here's an interesting study, from 2017. It supports dose-escalated RT + ADT for high-risk cases. Many of us here have had pretty much that protocol. It's a retrospective study so it has the usual inherent selection-bias risks. But it does use quite contemporary treatment protocols, with RT using the levels currently being delivered. Only two patients had less than 75 Gy dose.Superior metastasis-free survival for patients with high-risk prostate cancer treated with definitive radiation therapy compared to radical prostatectomy
It's encouraging that metastases were delayed by RT, though also of note there was no difference in overall survival vs RP.
From the article:Conclusions
This propensity-score-matched analysis from a single
institution using contemporary treatments corroborates prior
reports that dose-escalated RT as primary treatment for HRPCa
is at least comparable with RP for disease control.34-36
Our data suggest that RT with concurrent/adjuvant ADT
may be superior for preventing development of distant metastases.
When considering the higher toxicity associated
with RP followed by either adjuvant or salvage RT and the
higher rates of salvage therapy overall, definitive dose escalated
RT and ADT may be an overall better primary
therapy for men with high-risk prostate cancer.
55@Dx on 4/16/13. PSA 5.2, G9(5+4), cT3a by MRI.
IGRT - 44 sessions (79.2 Gy, 50.4 Gy pelvic)
ADT2 - Lupron+Casodex (3 yrs)
PSA <0.1 : 8/13 - 5/16; steady at 0.7+/- 0.1 since 3/17My Story
Post Edited (Redwing57) : 7/5/2018 6:13:47 PM (GMT-6)