Generally, I do not recommend systemic therapy for such patients. If doing so, it would be intermittent ADT (alone) for 6-or 9-month cycles. The EMBARK study will hopefully address this important question.

Look at the patient life expectancy, PSA velocity, PSA doubling time, initial stage, Gleason's grade group, PSA level at the time of definitive therapy when deciding whether to begin ADT in this setting.If life expectancy is less than 5 years, if PSA doubling time is more than 12 months, consider ob...