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    ADT plus salvage RT lowers PCa metastases, raises survival

    Framework may help clinicians individualize therapy to reduce side effect risk

     

    Side effects differ between studies

    Using this type of framework can allow us to individualize the therapy in order to reduce the risk of side effects to those individuals who are less likely to benefit from the addition of ADT. These side effects in both studies were different, as expected, due to the type of hormone suppression used. In RTOG 9601, gynecomastia was noted in up to 70% of men and a higher risk of liver toxicity was noted. In GETUG-16, the use of goserelin was associated with a significantly high rate (45%) of hot flashes and sweating when compared to the salvage RT-alone group. Other potential side effects from hormone therapy, such as worsening of cardiovascular morbidity, were not reported.

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    Still, some questions remained regarding the type and the duration of ADT. Is it better to use bicalutamide for 2 years compared to goserelin for 6 months, especially since the latter study has not shown a decrease in metastases or improved survival? Or could more potent antiandrogens such as enzalutamide (XTANDI) be used for a shorter duration and with improved benefit?

    While we await the answers to some of these questions through ongoing clinical trials, patient factors and tumor factors such as life expectancy, pre-salvage RT PSA, and adverse pathologic features are the most important variables that can help the clinician select the patients who are most likely to benefit from the combination of ADT with salvage RT.

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