Salvage ADT after failure of radiation therapy - "NEW" PROSTATE ...

Posted on July 25, 2012 by Sitemaster

The art of good timing and good patient selection is important to the appropriate use of salvage hormone therapy in all men who are in biochemical failure after first- or second-line radiation therapy. A study published in ?the Red Journal? helps to make this point.

Myrdin et al. carried out a secondary (retrospective) assessment of data from the Irish Clinical Oncology Research Group 97-01 trial. The original study was a randomized clinical trial designed to compare the benefits of 4 months as opposed to 8 months of neoadjuvant androgen deprivation therapy (ADT) + radiation therapy (RT) in men with intermediate- and high-risk prostate cancer. Myrdin et al. wanted to use data from this study to evaluate the survival benefit of early vs late salvage ADT is the men who progressed after initial neoadjuvant ADT + RT.

The authors identified 102 participants in the original trial who had a clinically significant recurrence of their disease at an average (median) follow-up of 8.5 years. These 102 participants were then classified into one of three groups:

• 57 patients had PSA levels of ? 10 ng/ml and no distant metastases at initiation of salvage ADT (Group A).
• 21 patients had PSA levels > 10 ng/ml and no distant metastases initiation of salvage ADT (Group B).
• 24 patients had distant metastases at?initiation of salvage ADT (Group C).

The authors then set out to assess overall survival of the men in each of these groups from two different time points:

• Time point 1 was the date of enrollment in the original trial.
• Time point 2 was the date of initiation of salvage ADT.

The analysis of overall survival based on the three pre-specific groups and the two time points showed the following:

• Overall survival from time point 1 at a median follow-up of 10 years was
  • 78% for patients in Group A
  • 42% for patients in Group B
  • 20% for patients in Group C
• Overall survival from time point 2 at a median follow-up of 6 years was
  • 70% for patients in Group A
  • 47% for patients in Group B
  • 22% for patients in Group C
• The average (median) time from end of RT to biochemical failure was
  • 3.3 years for patients in Group A
  • 0.9 years for patients in Group B
  • 1.7 years for patients in Group C
• The average (median) PSA doubling time also varied by group, as follows
  • 9.9 month for patients in Group A
  • 3.6 months for patients in Group B
  • 2.4 months for patients in Group C
• On multivariate analysis, timing of salvage ADT, time from end of RT to biochemical failure, and PSA nadir on salvage HT were all significant predictors of survival.

It is apparent from this study that, at least in men with intermediate- and high-risk prostate cancer, early use of salvage ADT (i.e., in men with a PSA level? ? 10 ng/ml and the absence of distant metastases) is likely to be associated with longer survival after failure of initial treatment with neoadjuvant HT + RT.

It is also reasonable to hypothesize that (with the same condition that PSA levels are ? 10 ng/ml and there is no evidence of distant metastases), men with less aggressive cancer and longer PSA doubling times after first-line radiation therapy may well be able to defer initiation of hormone therapy for a while as opposed to initiating hormone therapy at the very first signs of a rising PSA.

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Filed under: Diagnosis, Living with Prostate Cancer, Management, Treatment Tagged: | ADT, androgen deprivation, radiation therapy, salvage, survival

Source: http://prostatecancerinfolink.net/2012/07/25/salvage-adt-after-failure-of-radiation-therapy-the-art-of-good-timing/

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