The RADAR study looked at 6 vs 18 months of ADT along with radiotherapy. One of their main results was 30% fewer prostate cancer specific deaths in the 18 month arm after 10 years.
I've looked but can't find the actual number of prostate cancer specific deaths. I believe the original enrollment was around 1000 so it makes a big difference if the PC specific deaths dropped from 10 to 7 or from 300 to 210. Both are 30% drops but the actual numbers say a lot about survivaility on ADT.
Also, concerning survivability, they also found no difference in overall survivability between the two groups. It's surprising that a treatment can reduce prostate cancer deaths by 30% but have no difference in overall deaths. Two possibilities come to mind. One, the number of prostate cancer deaths were so small that they got swamped by the overall deaths. Two, fewer died from prostate cancer in the longer arm but we're killed by heart attacks and other SEs of ADT. Or a third (likely) possibility. I don't understand this trial at all.
Any insights from those of you talented in clinical trial analyses?
Reachout, we have similar stats, are you looking into seeing a RO and MO? What is your plans please as I am trying to figure out what to do? I will call tomorrow to make appointments with both.age 63 now, diagnosed on 2012 at 58 years old, 5 years ago RP 2012, Gleason 3+4, positive margins and extra capsual extention. T2c. Psa on 11/2016 .07 Started external beam radiation on 1/2017 Psa 7/2017 .1 Psa 11/2017 .16 Psa 1/30/2018 .20
Right now I'm just trying diet changes to increase my doubling time. It's about one year right now so it's not critical. I am seeing a RO and a urologist right now but if it gets to .7 the RO is going to refer me to a MO team plugged into clinical trials. Those trials might iclude SRBT to micromets and / or immunology. If it keeps rising and gets to 1 or 2 I will consider intermittent ADT depending on doubling time, especially if it's under 9 months.
Your doubling time is a bit faster. If I were you I'd find a good MO and think seriously about ADT at 1 or 2. But I think you're also trying the diet so hope that works for you. Don't expect your MO to say much about diet.
Post Edited (reachout) : 2/11/2018 7:02:17 PM (GMT-7)
Thanks reachout but aren’t you interested in getting a PET scan. And see If your pelvic lymph nodes haven't been treated and they are positive on the PET scan, you can have salvage radiation there. (with adjuvant ADT)? This is what tall Allen has suggested to meage 63 now, diagnosed on 2012 at 58 years old, 5 years ago RP 2012, Gleason 3+4, positive margins and extra capsual extention. T2c. Psa on 11/2016 .07 Started external beam radiation on 1/2017 Psa 7/2017 .1 Psa 11/2017 .16 Psa 1/30/2018 .20
Yes, that's what I meant by SRBT. Have a PET scan and If appropriate get them zapped by SRBT. But even if that happens I don't expect it to be a cure, just hopefully delay things a year or two. Really, my main hope right now is the diet and supplements. I'm taking Pomi-T and modified citrus pectin along with a Mediterranean diet with fruits veggies and fish. No eggs, dairy, or beef. I'm also eliminating poultry.Age: 73 2009 PSA 5.6, DaVinci 9/09, path G 4+3, - M, NX, MX, T2c Post-surgery PSA nadir <0.014, gradual rise to 0.26 over 3+ years. SRT 2/13. 39 sessions 70.2 Gys, minimal SEs. PSA nadir .01 6/14 PSA .014 12/14; .024 7/15; .027 11/15; <0.1 16-17; 0.2 1/18
So far I haven't gotten any answers to my questions, so I'm thinking all they have published so far is this abstract but are keeping the rest of the data until they publish a paper. Tall Allen, can you give me any insights here?Age: 73 2009 PSA 5.6, DaVinci 9/09, path G 4+3, - M, NX, MX, T2c Post-surgery PSA nadir <0.014, gradual rise to 0.26 over 3+ years. SRT 2/13. 39 sessions 70.2 Gys, minimal SEs. PSA nadir .01 6/14 PSA .014 12/14; .024 7/15; .027 11/15; <0.1 16-17; 0.2 1/18
Maybe you are familiar with the more explicit 2014 report, 7.4 years of follow-up: http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(14)70328-6/abstract67 years old. PSA: 2008:2.8; 2012-2016: 4.5-5.5. May, July 2017: 6.1, 7.6 mpMRI, July 2017: PIRAD5 5. Dx August 2017,Gleason 3+3, 2 cores, left 5%, right 3%. Prostate about 100 g. DRE +. Manual LRP, november 6, 2017. Pathological report: less than 20% involved. G 5+3. Clean margins, not other features.
jmadrid yes that helps. So at 7.4 years they had 4.1% to 7.8% prostate specific mortality depending on what group they were assigned to. They also had 13.9% to 19.4% overall mortality.
I think I see where I misinterpreted one of their findings. I thought they found no difference between prostate cancer specific mortality and overall mortality. Now I see that what they are saying is that they found "no change in ... all-cause mortality between the two groups." That is, the overall mortality was higher than prostate cancer specific mortality, but there was no difference in overall mortality depending on whether they used 6 months or 18 months of ADT. I guess. I hope the Tall One will let me know if I still didn't get this right.
Anyway, my interest in this study was not so much the difference between 6 and 18 months of ADT (although that is very interesting and the main point of the study), but the survivability of men on ADT after 10 years. At 7.4 years it was about 94% which are very good stats especially for the mean chosen that had locally advanced prostate cancer. I wonder though if this was the knee of the curve and the mortality rates increased a lot between 7.4 and 10 years. I am also still wondering if the overall mortality was related to ADT use or if the mortality rates were consistent with what would be observed in a cohort of men of the same age and overall health. Of course, since PC specific mortality is a subset of overall mortality, I would expect the overall to be higher than in a non cancer cohort but hopefully not significantly higher.
OK I will stop now, my head hurts.Age: 73 2009 PSA 5.6, DaVinci 9/09, path G 4+3, - M, NX, MX, T2c Post-surgery PSA nadir <0.014, gradual rise to 0.26 over 3+ years. SRT 2/13. 39 sessions 70.2 Gys, minimal SEs. PSA nadir .01 6/14 PSA .014 12/14; .024 7/15; .027 11/15; <0.1 16-17; 0.2 1/18
That study was among men getting primary radiation therapy with adjuvant ADT for intermediate or high risk PC. What relevance do you think it has for you?Allen - not an MD •PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement •SBRT 9 yr onc. results •SBRT 7 yr QOL results •treated 10/2010 at age 57 at UCLA,PSA now: 0.1,no lasting urinary, rectal or sexual SEs my PC blog
That study was among men getting primary radiation therapy with adjuvant ADT for intermediate or high risk PC. What relevance do you think it has for you?
Fair question. It does not apply directly, or may not apply at all, as far as how long ADT was used for, or the prostate cancer specific survivability.
I am more interested in what they observed as the differences between the prostate cancer specific and overall survivability of the men in the study, regardless of how long they were on ADT. As you know, I am contemplating beginning ADT at some point in the future. If this study finds that men are surviving prostate cancer but are disproportionally dying of heart attacks, diabetes, or some other side effect of ADT, I think that would have some relevance to my choice as to when to begin ADT.
I'm sure the study will not address that directly. But maybe they would have statistics on, for example, the average age of men in the study and the number that survived for 10 years. If their overall survivability, after adjusting for prostate cancer deaths was, say, twice as high as we would expect for men that age, don't you think that might raise some questions about whether ADT was in itself increasing PC survivability but lowering overall survivability? Do you know of studies that have specifically looked at that question?
In this case I do not think there is much indirect PCa mortality. According to the mskcc nomogram the expected 10 year mortality without any current pathology is 22%. This is for my age, maybe the average age of this cohort is lower. But, in any case, 7 year difference between PCa and overall mortality is even smaller than expected.67 years old. PSA: 2008:2.8; 2012-2016: 4.5-5.5. May, July 2017: 6.1, 7.6 mpMRI, July 2017: PIRAD5 5. Dx August 2017,Gleason 3+3, 2 cores, left 5%, right 3%. Prostate about 100 g. DRE +. Manual LRP, november 6, 2017. Pathological report: less than 20% involved. G 5+3. Clean margins, not other features.
Post Edited (jmadrid) : 2/12/2018 1:21:26 PM (GMT-7)
The relationship between pc-specific survival and overall survival is much more complicated than you imagine, and your wanting to ascribe more deaths to 18 months of adjuvant ADT (vs 6 months) is completely inappropriate. There is no evidence for your inference that ADT causes diabetes or CV disease. Those and other comorbidities increase with age, as does incidence of PC. In most RT studies, the median age is about 70. There are no valid conclusions for you to draw from this that is relevant to your case.Allen - not an MD •PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement •SBRT 9 yr onc. results •SBRT 7 yr QOL results •treated 10/2010 at age 57 at UCLA,PSA now: 0.1,no lasting urinary, rectal or sexual SEs my PC blog
This might have some relevance to the question of ADT effectiveness, and addresses my concerns over the true value of ADT compared with quality of life and overall survivability.
The objective was to "evaluate the overall survival (OS) and disease-specific survival (DSS) in men receiving primary androgen-deprivation therapy (PADT) or salvage medical ADT (SADT) for prostate cancer."
The conclusion: "PADT and SADT prolong survival in men with prostate cancer... Hormone Resistant Prostate Cancer portends a poor Disease Specific Survivability ... However, most men died from causes unrelated to prostate cancer, thus questioning the true value of ADT in prolonging patient survival."
Pretty much what my oncologist told me, except for the "questioning the true value of ADT" part. I am just trying to collect info to make an intelligent decision. All I hear from the medical community is that ADT is the standard of care, which I agree it is. But I want to know what my chances are if I choose to live maybe a marginally shorter life but with a higher quality of life versus a marginally longer life of miserable quality followed by a pallitated cancer death. At 72 with no children to raise I think that is a fair question.
You are making a fallacious assumption that quality of life is better if you wait.
Overall survival with advanced PC is a complex issue - the patient often dies of something else that goes from sublethal to lethal due to the debilitating accumulation of cancer in his body. For example, diabetes or CV disease that might not ordinarily kill you may become the cause of your death when your body is full of cancerous tissue.Allen - not an MD •PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement •SBRT 9 yr onc. results •SBRT 7 yr QOL results •treated 10/2010 at age 57 at UCLA,PSA now: 0.1,no lasting urinary, rectal or sexual SEs my PC blog
It appears that most on this board are considerably younger than me, with different issues. One of the many side effects of aging. So I think it's best if I make decisions based on my state in life. All the best to everyone here.
"According to Dr. Morgans, understanding the complications of systemic therapy for prostate cancer in elderly men is critical. .. Morgans notes that ADT is associated with numerous complications that should be considered when caring for prostate cancer survivors. Elderly men are particularly vulnerable to developing complications from ADT that increase morbidity and mortality. Importantly, this may lead to loss of mobility, loss of independence and increased financial burden."
If you are old and frail, any therapy is more debilitating. You should only base such decisions based on physiological age - not chronological age. One man of 92 in my support group happily pops his 50 mg Casodex pill everyday and is in great spirits and remains happy and healthy. i strongly recommend trying it before you knock it. Fear is not a good stance from which to make a decision - personal knowledge is much better.Allen - not an MD •PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement •SBRT 9 yr onc. results •SBRT 7 yr QOL results •treated 10/2010 at age 57 at UCLA,PSA now: 0.1,no lasting urinary, rectal or sexual SEs my PC blog
What two absolute facts are 1. We’re all going to die, and 2. None of us are sure of when, or what will cause it. Having PCa just compounds these mysteries.
Much of the frustration I’ve had, and that I read on this forum are from brothers seeking absolute answers, when none exist. All the studies are averages, means, and well thought out estimates of men with an infinite number of variables, none of which EXACTLY match any one of us. So, in reality, what we get is a general indicator. Informed; yes - Exact; no.
The bottom line for me is to keep researching, asking questions, looking for trends....while not taking anything as gospal. Nothing but death and taxes is certain.
Gotta leave for my simulation and final full body scan appointments.
Post Edited (garyi) : 2/13/2018 6:59:31 AM (GMT-7)
All the best with your procedure, Gary.Age 75, excellent health except PCa Psa 7/13=8 with BPH, 7/17=23.8 7/20/17, Biopsy, 5/12 cores PCa all right side, Gleason 4+3, PNI PSA 9/17=20.44 MRI and CT no evidence of metastases Laparoscopic surgery MSKCC 10/31/17, left nerves spared, pathology T3aN0, G4+3, focal EPE, negative margins Continent but ED 12/14-psa 0.10, 1/25-0.11, appt with RO 3/6
Progressing said... All the best with your procedure, Gary.
Thanks, Progressing.
Simulation was interesting. Mold; too much water, water filled rectal balloon, small tats at end. Took long than I expected, and shame on me that I didn't realize it was on a Phillips MRI machine. Anyway over now, and the real RT starts in under three weeks.
My PSA is down to .07 thanks to two months of ADT.
