Worth the wait?

Top Line: There remains heated debate on when to add androgen deprivation therapy (ADT) to salvage radiation for biochemically-recurrent prostate cancer.

The Study: This iteration brings the debate to “salvage” radiation for PSMA-detected nodal and/or oligometastatic (i.e. <5 mets) disease. We’ve seen in a smaller series that early, and even subsequent, mets-directed radiation alone can spare or delay the initiation of ADT in many oligorecurrent patients. This larger retrospective look at 305 patients reports on biochemical control, ADT-free and overall survival, and toxicity. Here 115 (38%) patients received ADT in addition to radiation for first salvage. As expected, those receiving ADT had significantly longer biochemical recurrence free survival. However, in line with other studies, 93% and 83% of those without ADT at first salvage went at least one and two years, respectively, without initiating ADT. Again, this was achieved at the expense of the majority (85%) requiring further mets-directed radiation. So, in the end, the question becomes: would your patients rather have a couple of rounds of (often) a few days of radiation or indefinite castration level testosterone?

TBL: Continued mets-directed radiation can delay the need to initiate ADT in oligorecurrent prostate cancer, representing another therapeutic strategy to discuss with patients. | Kroeze, Eur Urol 2021