Lots of goof points! PDA, interesting that "the catch-22s of cancer research. By the time you follow the subjects long enough...... How many of the men in the high-PSA group had those high readings because they waited a long time while the PSA rose slowly and how many had really short doubling times?.... Also, the ADT in the study was high-dose bicalutamide (an antiandrogen). I don't think there are that many of us here on the forum who have gone with an anti-androgen mono-therapy for ADT.".
Also, it is the lower PSA group that had the greatest increase in risk of all cause mortality.
They found that — as in the original trial — patients with PSAs higher than 1.5 ng/mL showed improved overall survival (HR 0.45 [0.25-0.81]). For men with PSA levels lower than 1.5 ng/mL, however, there was no survival benefit (HR 0.87 [0.66-1.16]).
Spratt and colleagues also assessed the data for the subset of patients with PSA levels less than or equal to 0.6 ng/mL, which they noted is closer to today’s standard for post-surgical radiation treatment (as opposed to the standard at the time the RTOG 9601 trial was enrolling patients, when PSA levels were allowed to rise before initiating radiation therapy). And that data, Spratt said, "demonstrates that men with lower PSAs are more harmed than helped by long-term hormone therapy."
"We have now 3 randomized trials with over 2,400 men that do not demonstrate that short- or long-term hormone therapy improves overall survival in men receiving early salvage radiotherapy at low PSAs," said Spratt. "PSA prior to salvage radiotherapy predicts who will benefit most from hormone therapy and guidelines should now be updated to reflect this finding.",,,,,,,,,,,
So, as others have pointed out, once you have mets or are likely to(higher PSA), those who really need the HT, you have to go with HT. What with mets being the likely alternative to not doing so, which is more dangerous to you than the increase in all cause mortality(ACM), if any.
Isn't it odd that the lower the PSA when SRT/HT is started, the greater the increase in ACM? And just as odd: the men with the higher PSA at the start- presumably the ones at higher risk for PC specifc death- not only had a lower risk of death from PC- but also less all cause mortality, rather than worse as in the low PSA group. What's up with that?
Whatever damage to the system that HT might cause along with damage to PC cells- wouldn't it cause just as much system damage in the guys with higher PSA, and increase- rather than decrease- their ACM, same as the low PSA group? That one is warping my mind.
I'd like to see the all cause mortality rates for the low PSA placebo group to compare to the same for the high PSA placebo group. Could there be some over all health characteristic in the lower PSA group, that would have given them lower ACM, compared to the higher PSA group? That is, before this theoretical advantage was damaged by HT? I'm just making wild ass guesses here guys, for what could account for improved ACM in the high PSA group vs worsened ACM in the low PSA group. ?????????????????????????
One more question: is PC specific death included in the ACM #s? Or do they remove PC specific death from the ACM #s, wanting to look at everything but death from PC? If so, if the numbers were great enough to influence the over all averages, wouldn't you expect the higher risk guys to have greater reduction in PC specific death due to HT, compared to the lower risk guys who had a much lower chance of PC specific death to start with? And if included in the ACM, wouldn't therefore ACM be improved? Again, just guessing wild here guys. I have no clue.
PSA 10.9 ~112013
Bx on 112013 at age ~65yrs, with 5 of 12 pos, G9(5+4), T2B.
RALP with lymph nodes at Vanderbilt 021914. (nodes clear, SV+, G9 down graded to 4+5, 1 focal margin )
only rare pad use after 1 year
PSA <.01 on 6/14 and all until 9/15 = .01, still .01 9/16, .02 on 3/17,6/17,10/17, .06 1/18, .06 4/18, <.05 7/18, .06 10/18, .06 04/19
Post Edited (BillyBob@388) : 9/20/2019 7:46:21 AM (GMT-6)