What would your approach be in a man currently on treatment for high-risk prostate cancer with ADT who does not have castrate levels of testosterone?
A patient with low-volume but high-risk prostate cancer (Gleason 8 disease) has completed a course of RT and remains on ADT with 3-month depot injections. His PSA is undetectable, but his testosterone is not at a castrate level (≈200). Would you modify therapy or keep things as is since his PSA is so low?
3 Answers
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Radiation Oncology · Memorial Sloan Kettering Cancer Center
Answered on
Yes, I would try alternative agents. If using Lupron, consider relugolix, degarelix, high-dose bicalutamide, or even adding an ARSI.
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Radiation Oncology · UC San Diego
Answered on
I would switch to a GnRH antagonist or add another agent.
It is perhaps worth noting that most (all?) randomized trials of ADT with RT combined agonists like leuprolide with bicalutamide. Ongoing trials (NRG-GU010, NRG-GU009) still require this. There is an interesting biological explanation for why ...
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Radiation Oncology · Hôtel Dieu de Lévis - CISSS Chaudière-Appalaches
Answered on
I would first measure testosterone using mass spectrometry. There's a fair probability in this case that testosterone is already at castrate levels.
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