Would you add ADT to EBRT for favorable intermediate risk patients with T1c prostate cancer by DRE and bilateral prostatic lobe involvement by MRI?
Would gene expression testing (e.g., Decipher, Prolaris, Oncotype DX) guide your management recommendations?
Answer from: Radiation Oncologist at Community Practice
Let's break down the question:
If the patient has favorable intermediate risk disease, but cT1c by DRE, then he must have either:
Grade group 2 (Gleason 3+4), PSA <10, and percent positive cores <50%; or
Grade group 1 (Gleason 3+3), PSA 10-20, and percent positive cores <50%
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Answer from: Radiation Oncologist at Academic Institution
Generally speaking, I would not add ADT for a man with favorable, intermediate risk disease treated with EBRT. These men have a high chance for biochemical control, and low chance for cancer mortality (<5%) at 10 years with RT alone, and the added benefit of for ADT is small, probably not making ...
Comments
Radiation Oncologist at Case Western Reserve University/ University Hospitals Seidman Cancer Center In response to Dr. @Liauw, who is very thoughtful ...
Radiation Oncologist at University of Chicago Thanks for the follow-up discussion, @Dan.
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Radiation Oncologist at Saint Lucie Radiation Oncology Great points @Dan. I completely agree with Dr. Spr...
Radiation Oncologist at Case Western Reserve University/ University Hospitals Seidman Cancer Center @Stanley Liauw - you may be correct and I would no...
Radiation Oncologist at Saint Lucie Radiation Oncology It appears Dr. @Spratt is correct and the PSA fail...
Radiation Oncologist at University of Chicago The first long term update of the MDACC dose escal...
Radiation Oncologist at Case Western Reserve University/ University Hospitals Seidman Cancer Center Appreciate the discussion and agree on the value o...
Answer from: Radiation Oncologist at Community Practice
Great discussion! The eContouring resources have been great for learning the technical aspects of prostate SBRT/hypofx/MRI fusion after training. The ASTRO refreshers, in my opinion at least, from the mid-2010s were too focused on data minutiae and not practical treatment planning but not sure about...