Now what?

There has been a tremendous expansion of effective treatment options for men with prostate cancer who progress after definitive treatment, but how long do men have to wait to get it? This study analyzed PSA three months post-radiation with ADT for VA patients with intermediate and high risk disease. PSA levels were categorized into three groups: 60% were undetectable (< 0.1), 40% were low-detectable (0.1-0.49), and 10% were high-detectable (≥0.5). Looking at the figures, there’s a very nice spread in biochemical failure and cancer specific mortality across groups. Importantly, men with a PSA of at least 0.5 had a 10% decrease in overall survival at 10 years, supporting a similar observation in the secondary analysis of the D’Amico trial. So what should you do for these patients? Right now, there isn’t much. What they need are trials looking at more adaptive approaches to adjuvant therapy using early red flags. TBL: A PSA of 0.5 or more at 3 months out from radiation with ADT for intermediate and high risk prostate cancer is associated with inferior prostate cancer outcomes and even survival. | Bryant, Cancer 2018