Do you account for prostate shrinkage during XRT if ADT is started concurrently?

This is a common question since we reported the study results, and a valid one for sure. Stay tuned for an even larger meta-analysis of many more RCTs that further dives into the oncologic superiority of adjuvant compared to neoadjuvant ADT. However, to your question, what about toxicity?

Here are my...

Start ADT, wait 8 weeks or thereabouts, planning scans, and start RT.

My experience from years of pubic arch studies both before and after androgen deprivation is that in a majority of patients, most of the cytoreduction is done in 2 to 2.5 months from initiation of androgen deprivation. So I usually wait 3 months to plan. I am sure there are a few who continue to shr...