Dr. Zhu on the Role of ADT in Pelvic Node–Positive Prostate Cancer

Jason Zhu, MD, a medical oncologist at Levine Cancer Institute, Atrium Health, discusses the role of androgen deprivation therapy (ADT) in patients with pelvic node–positive prostate cancer.

For patients who have positive nodes following surgery, there is only 1 prospective, randomized, controlled trial that addresses the role of ADT; this research was led by Edward M. Messing, MD, of the University of Rochester Medical Center, and was published in the New England Journal of Medicine in 1999, according to Zhu. It was a small study that was conducted during a time when prostate-specific antigen (PSA) levels were not reliably checked before and after surgery, Zhu says.

In the study, a notable difference in overall survival (OS) was observed in patients who started ADT immediately vs those who delayed treatment; this treatment was often utilized when patients developed bone metastases, Zhu explains.

Practice has since changed, according to Zhu. ADT is frequently used much sooner in the treatment paradigm. Moreover, watching PSA doubling times and for biochemical recurrence is now common practice. The research revealed that starting ADT early provided an OS benefit, Zhu concludes.