This showed up in my inbox and I found it interesting.
It appears to be focused on initial treatment rather than a salvage setting, and showed that even for those newly diagnosed with advanced prostate cancer that had already spread, there was benefit to radiating the prostate:
“The initial 2018 findings of this arm of the STAMPEDE trial were slightly surprising. Previous thinking was that if the cancer had spread then the horse had bolted and there was no point in shutting the stable door by treating the original disease site. These long-term results have confirmed that this is not the case, and by treating the original site after the disease has spread, some men with prostate cancer lived longer than those on hormonal therapy alone. This could potentially benefit people with other cancers that have spread to other parts of the body too.”
Professor Nick James, Professor of Prostate and Bladder Cancer Research at the ICR, and Chief Investigator of the STAMPEDE trial
Here is the link to the original article:
Long-term benefit of radiotherapy confirmed in advanced prostate cancer
Dan's Journey through Prostate Cancer 
Thanks Dan, this is indeed interesting. The advancement in medicine and specifically and prostate cancer research is increasing rapidly. I suggest that even in five years from now it will be an entirely new landscape. My external beam radiation will be likely in September sometime, and Victoria , BC. Your blog has put me someone Eddie’s. I thank you for that immensely. What interesting point was that although my PSA is a .12 currently in my operation was in March 2021, I thought I would have to do around or two of ADT . My oncologist said that due to my age ( 58) the nature of my case and the low risk type 3 Gleason , ADT would only be a very small fraction, ~3%, more efficacy ….so he didn’t recommend it . He commented if the PSA ever rose again after EBR (which he doubts), we could always consider ADT, chemicals, and re-radiation at that point. He is very well respected and experienced radiation oncologist and works with many urologists seamlessly. I was surprised though ….no ADT recommended .
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Hi James,
Sorry I didn’t see this sooner. Your comment was classified as spam by WordPress for some reason.
Your oncologist’s numbers for improved efficacy seem to be reasonable based on what my RO told me in my case. He thought that, given where my PSA was at going into this (0.36) and its decreasing doubling time, he thought the ADT would make the SRT 10% or so more effective. Obviously, I chose to do it concurrently, as I’m a bit farther down the road than you are and I figured every little advantage I can take, I will.
All the best as you go forward.
Dan
P.S. I’ll check the spam folder more frequently.
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Thanks for your support and knowledge Dan ! Bets of luck with everything . I start EBRT on Sept 19 ……
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Hi Dan, I found this particularly interesting as it applied to my treatment experiences.I was treated in 2017 a year before 2018 when this conclusion was first drawn in the Stampede trials. I had read about PCa before my consultation and decided I would ask for a robotic prostatectomy with nerve sparing. However, as the cancer was locally advanced beyond the prostate to the seminal vesicles I was told that my only option offered was hormone therapy for life and 6 sessions of chemotherapy with docetaxel. As the article said the thinking was the horse had bolted and treating the primary site was not an option. This did give me two years very low PSA however I experienced a biochemical recurrence after about 30 months. I had gained a lot more knowledge by this time and I then had a PSMA PET at my own expense and initiative which clearly showed that the cancer had recurred within the prostate. If I had not taken that initiative the likelihood is that I would have been left on ADT until something showed up on a CT scan or a bone scan which at that time were coming back negative. The PSMA PET scan resulted in my being given 20 fractions of radiotherapy to the prostate and seminal vesicles. This only gave a very short period of PSA suppression and it began to rise again and then I went again on my own initiative for a second PSMA PET scan. On the positive side it showed no disease persisting in the prostate or abdominal lymph nodes but it did show it had spread to other lymph nodes in my chest. Again as a result of the PSMA PET scan I was then put onto Enzalutamide in November 2021 and my current situation is that my PSA is undetectable. In breast cancer the approach is radically different in that the primary sites are removed by surgery, then chemo and radiotherapy follow plus other hormone therapy. I wonder if I had been given radiotherapy along with my ADT and chemo I wonder if I would have avoided this spread to distant lymph nodes? Water under the bridge for me. Prostate cancer treatment is a rapidly evolving scenario as you know.
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Hi Charles,
Thanks for sharing your details. It’s good that research on the treatment continues to move forward and offers new options to patients, but when we miss out on those options because of timing, that can sometimes be a bitter pill to swallow. But once it’s water under the bridge, the only thing we can do is look forward and not play the “What if?” game.
Best,
Dan
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