when to start ADT along with SBRT

laojia

Hi, due to scheduling delays I won't be able to start SBRT (cyberknife) for my Gleason 4+3 multi-focal PC until September. My PSA jumped in October last year from 2.7 to 4.6 in 16 months time. I did not get a biopsy until April which shows two localized tumors about 1 cm each. 70 percent gleason pattern 4.
I would like to start a 4 to 6 months ADT asap to prevent tumor further grow/spread. However the radiation oncologist insists not starting ADT until after SBRT treatment for better effect. I have read that ADT should be started 2 month before radiation in order to weak the tumor cells before radiation. I am right?

Clevelandguy

Hi,

I guess there is no gold standard on before or after. Some sources say before, some say during, some say after.

Dave 3+4

Old Salt

I believe that you are correct (starting ADT prior to radiation).

I can also state that this was the protocol at Georgetown U radiation oncology where I had 'double' radiation therapy (SBRT first followed by IMRT).

Steve1961

have you had decifer testing yet to make sure the Gleason 4 is not Cribiform ..cribiform is radiation resistant ,,trust me i know it happened to me .. six years later, I had a reoccurrence and now I am recovering from salvage surgery. The Gleason 4 remained in the prostate. The radiation did not kill it. It wasn’t a new tumor. It was right there next to the marker. I had two surgeons tell me that they’re finding these days, that cribiform is radiation resistant so I would make sure that it’s not Cribiform form if I was you

laojia

https://csn.cancer.org/discussion/comment/1716309#Comment_1716309

I did have a decipher test which shown a score of 0.43, barely in the low risk category. the report did not mention Cribriform present or not, neither did my biopsy report. I asked a respected urological oncologist (Maxwell Meng at UCSF). He told me if there's no mention in the report, then it means "no" cribriform. The biopsy report did say "The Gleason pattern 4 types identified include poorly formed and fused gland types with mucinous features". I guess that is different than cribriform?

The decipher report did say:" if treated with radiation alone without concurrent hormone therapy, the patients have favorable outcomes". However my two tumors, one has 70% pattern 4, another 80%, solidly in the Unfavorable Intermediate risk category. I don't know if I can skip ADT even if decipher is border line low.

Old Salt

You should inquire how long the ADT would be for your case. Typical scenarios are 6, 12 and 18 months.