Why is there a benefit of ADT for high risk prostate cancer treated with radiation, yet no large trials describing benefit of adjuvant ADT after radical prostatectomy?
From a high level, the magnitude of the benefit of ADT with radiation seems proportional to the aggressiveness of the disease (i.e. low risk has no significant benefit, int risk weighs risk features and cardiac health, and high risk the benefit of ADT can trump cardiac risk).
In that context, we hav...
- Leveraging the ambiguity of the question, if we consider the “highest-risk” locoregional disease (i.e. node positive) adjuvant ADT showed a survival benefit over surgery alone in ECOG 3886. As mentioned above, finding a benefit to...
All interesting commentaries. Could there be a synergistic effect between RT and ADT whereby a diminished testosterone level enhances the sensitivity of the malignant cells in which RT is more effective in the local +/- the regional space, and could there be an abscopal effect in the distant space w...
My 2 cents on this topic.
Historically, "definitive" RT often cytoreduces a prostate cancer by something like 99.999% or a similar magnitude concept, rather than flat wiping it out forever (treated every cell but didn't kill every cell. It takes something like another 8 years for that outcome to be ...
Many moons ago, a famous urologist had quipped: “Prostatectomy only cures those prostate cancers that didn’t need to be cured and it doesn’t cure any cancers that needed to be cured”. In other words, prostatectomy only provides a generous biopsy. It adds little to the likelihood of a cure beyond wha...