When is it helpful to have ADT with salvage radiation?

Role of androgen deprivation therapy in early salvage radiation among patients with prostate-specific antigen level of 0.5 or less. By Parekh et al. 2014


Key sentence from the paper: “Even patients followed with ultrasensitive PSA and salvaged early with a PSA ≤ 0.5 seem to benefit from the addition of ADT to salvage radiation… this benefit seemed to be limited to men with negative margins; thus, men with positive margins and PSA ≤ 0.5 may be good candidates for salvage radiation alone.”


For the full abstract, see: http://www.ncbi.nlm.nih.gov/pubmed/25103271  


Commentary: Some patients who get a prostatectomy find that their PSA nevertheless continues to climb. This process is called biochemical failure. Those patients are then candidates for salvage radiotherapy, which uses external beam radiation to treat the area around where the prostate gland used to be. The effectiveness of this treatment depends on the extent to which any residual cancer has remained in or near the prostate bed.

But, should patients who go to salvage radiotherapy be on ADT? This paper shows that early salvage therapy when the PSA is very low is enhanced with ADT. However, if there is a positive surgical margin on the prostate gland removed in the prostatectomy, then the addition of ADT to the salvage radiotherapy does not provide additional survival advantage. 


Parekh A, Chen MH, Graham P, Mahal BA, Hirsch AE, Nakabayashi M, Evan C, Kantoff PW, Martin NE, Nguyen PL. 2014. Role of Androgen Deprivation Therapy in Early Salvage Radiation Among Patients With Prostate-Specific Antigen Level of 0.5 or Less. Clinical Genitourinary Cancer. 27 June 2014 [Epub ahead of print]