In high or very high risk prostate cancer, do you utilize combined androgen blockade in patients receiving definitive RT?
Do you have a preference for bicalutamide? Can abiraterone be used instead?
Answer from: Radiation Oncologist at Academic Institution
Approximately 25% of the patient population on STAMPEDE had a new diagnosis of very high risk, N0 M0 prostate cancer (defined by at least two of the following: T3/T4, Gleason 8-10, PSA ≥40). The hazard ratio for failure-free survival for this subgroup maintained significance at 0.21 (95% CI 0.15-...
Answer from: Medical Oncologist at Academic Institution
While improvements in FFS are superior in this M0 N0 (by conventional imaging) very high risk PC population treated with ADT/Abi and RT to the primary as compared to ADT alone, the impact on OS is still not known and we await randomized trials dedicated to this high risk RT-treated population, such ...
Answer from: Medical Oncologist at Academic Institution
Prior studies utilizing combined androgen blockade in the adjuvant or neoadjuvant surgical setting have similarly failed to demonstrate an overall survival advantage (McKay et al., PMID 30811282). At this time, there is no definitive evidence of survival benefit with this approach. However, there is...
Comments
Medical Oncologist at Stamford Health Thanks for both answers. Is bicalutamide still wha...
Answer from: Radiation Oncologist at Community Practice
Yes, I do use combined ADT, typically 12 mo in an attempt to take advantage of other endpoints of prostate treatment failure and success e.g., BFS, PFS, DFS, especially LC, etc. I would caution putting too much weight into OS with prostate cancer as long-term ADT following relapse, continuous or int...