What duration of ADT do you recommend for a patient with otherwise favorable intermediate risk features but a mpMRI showing gross extracapsular extension?

All of the responses so far are reasonable to me. I am assuming the patient is Gleason 3+4 with PSA <10 ng/mL. I am wary of applying a new technology to categorize patients to older trials (i.e., T3 on mpMRI and assuming that is the same as clinical T3 prior to MRI). That said, I can't call a patien...

For me, it would depend on what made the patient favorable intermediate risk (FIR) in the first place. If he has a Gleason score of 6, but was FIR because of PSA or T stage, I would advocate for 6 months of ADT. Long-term ADT is morbid therapy and Gleason score would be the dominant factor here. I w...

Great question.

In this case, because the current 4.2019 NCCN guidelines allows for mp-MRI to confirm the T-stage of the patient, in addition to the DRE, but NOT the CAT scan, the patient you note would be upstaged to a T3/III. Therefore, he would require long-term ADT.

The other good thing about th...

Hi @Dr. First Last. Long-time no hear from!! Lol.

So, I agree partly with what you say as to the morbidity of long-term ADT. But my assumptions in this case are based on potential life expectancy, age, that it is in fact a T3 cancer. So if it turns out that he is the stage III/T3, in this instance, ...

Zero, as long as a sufficiently “potent” RT technique is used...

This is an important question and I think a lot of different answers are acceptable. I would generally SBRT patients like that without too much concern (but then I use a more aggressive SBRT dosing).

Extrapolating from Stephenson's data on post-RP recurrent and recurrence with salvage RT, ECE alone...

4-6 months.