If we are considering de-escalation of ADT in unfavorable disease, we need to critically assess short term outcome metrics beyond just the Phoenix definition.
Thanks for reading. All the data here assumes NO ADT use in the patient population. If you add ADT, there is data suggesting that you need to reach a PSA of 0.1 within 6 months of the completion of radiation for the "best" outcomes. As you point out, kinetic data with and without ADT is vastly different. This is arguing that if, as a physician, your PSA kinetics for your patients are good enough, you can safely avoid ADT for many men where it is recommended - my opinion and one that I review with patients going over the data and toxicity.
Got it - I actually wondered that. If you are NEAR these curves, you are in great shape. Well in excess of 90% cure 5-7 yrs out. And yes, very common to see small bumps as testosterone recovers. Very little data published (near zero that I'm aware of). Phoenix definition would say, if it stays less than 2 - you are doing great.
Thanks for reading. All the data here assumes NO ADT use in the patient population. If you add ADT, there is data suggesting that you need to reach a PSA of 0.1 within 6 months of the completion of radiation for the "best" outcomes. As you point out, kinetic data with and without ADT is vastly different. This is arguing that if, as a physician, your PSA kinetics for your patients are good enough, you can safely avoid ADT for many men where it is recommended - my opinion and one that I review with patients going over the data and toxicity.
Got it - I actually wondered that. If you are NEAR these curves, you are in great shape. Well in excess of 90% cure 5-7 yrs out. And yes, very common to see small bumps as testosterone recovers. Very little data published (near zero that I'm aware of). Phoenix definition would say, if it stays less than 2 - you are doing great.