Bering Straight.

Like our North American ancestors, let’s take this ARTIC concept waaaaay further than it was supposed to go. Let’s talk (yet again) about salvage radiation and androgen deprivation (ADT) for prostate cancer. Channeling our inner @DrSpratticus, perhaps we should think of the PSA as an “anatomic” biomarker of disease. After all, countless analyses have shown us that the chances of biochemical control from salvage radiation are inversely proportional to PSA at the time of salvage. In other words, the higher the PSA, the less a patient benefits from only radiation to the prostate fossa. Here we have 10-year (almost) results from the GETUG AFU 16 trial that randomized men—all with PSA <2!—receiving salvage prostate radiation to +/- the addition of short-course androgen deprivation (ADT). The important long-term result is that (only) 6 months of ADT improved 10-year distant metastasis-free survival from 69 → 75%. TBL: We now have evidence the addition of ADT to salvage radiation diminishes distant mets, even when given for only 6 months and even when given at low levels of PSA—i.e., we really need another way to personalize the intensity of ADT in this population. | Carrie, Lancet Oncol 2019