What are the current recommendations for androgen blockade for patients undergoing salvage radiation after prostatectomy with PSAs between 0.6 and 1.5?

Just be a little careful here. Although Dr. Spratt did an amazing analysis and thorough presentation of the subgroups, one shouldn't look at PSA <=0.6 as a "cutoff". As Dr. Spratt pointed out in his presentation, the population on RTOG 9601 was mixed in terms of prognostic features.. Would you really routinely omit ADT in a person with Biopsy Gleason 9, Pathologic Gleason 8, tertiary 5, 80% involvement of prostate cancer?

My take home message from the subset is that it is appropriate and reasonable to omit ADT in persons who clearly have more favorable features (which of course remain undefined).

We are now in an era where we have better post-prostatectomy prognostic stratification tools like Decipher and next generation imaging. Look at al...

Based on the RTOG 9601 original report and the secondary analysis presented at ASTRO this year, there is an overall survival benefit for men at PSAs >0.6 ng/mL.

Thus, the standard of care for this population is to offer ADT.

The optimal duration and agent(s) to use have not been formally tested, except in the RADICALS trial which will compare short-term vs long-term ADT. However, all of those men will have received early salvage RT at very low PSAs.

Best,

Dan