Decipher me this.

A post-hoc secondary analysis of RTOG 9601 suggested the addition of 2 years of bicalutamide to salvage prostate radiation is beneficial only in the setting of higher PSA recurrences, and maybe even detrimental with a low PSA. A second secondary analysis now demonstrates the same for high versus low Decipher scores. Patients with a low-risk score (<0.45) saw a survival advantage of just 2% compared to 9% among those with a high-risk score (>0.6). When they looked at Decipher scores among men who had a PSA < 0.7, those with a low-risk score had a survival detriment of 8% with ADT compared to an advantage of nearly 5% with a high-risk score. This all suggests that pre-salvage PSA and genomic predictors of distant recurrence are strongly suggestive of the relative benefit of adding ADT to salvage radiation. And in men with a low PSA and low genomic risk score, you may feel more comfortable omitting ADT. | Feng, JAMA Oncol 2021


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