Do you recommend adjuvant ADT instead of neoadjuvant ADT with prostate RT?

If ADT and RT are synergistic rather than additive, then the sequencing of therapies should matter.

Neoadjuvant:

ADT has been shown to reduce proliferation and cell cycling (increase radioresistance) and decrease hypoxia (increase radiosensitivity). However, tumor hypoxia is not a major driver of ou...

At Banner MDACC, we typically had been following Houston’s guidance to start ADT before RT, and wait until PSA came below 0.5. This was based on retrospective data suggesting that patients with good PSA responses had better outcomes. The logic of this approach did not seem to make sense - that data ...

Appreciate the comments of all and also appreciate the sense of caution. It has been standard to wait for confirmatory studies before making substantial changes of practice. However, I would offer that this is not a substantial change in practice. We are talking the same drug (my personal choice com...

I think Dr. @Dr. First Last stated it very well. Much of the data we use, such as from EORTC, already started ADT with RT without neoadjuvant RT (so did multiple intact and post-op RTOG trials).

Even if you ignore the meta-analysis and you look at the individual trials, RTOG 9413 showed no advantage ...

I would be just a bit more cautious in changing practice for now. I don’t think we really have a clear idea of exactly how and why hormonal therapy works with radiation. Especially as we move to hypofractionation and SBRT. Other hypothesis have been generated outside the usual suspects of radiobiolo...

Thanks, @Dr. First Last. Are you using LHRH analogue alone or combination ADT if skipping the neoadjuvant phase? I prefer to continue with 2 months of neoadjuvant ADT (we use LHRH analogue alone for 'simplicity' as well) with the rationale being not to lose any synergistic effects due to the lag in ...