There are few scenarios with more data and less clarity than when to add androgen deprivation therapy (ADT) to definitive radiation for prostate cancer. The challenge is individualizing the risk of clinically meaningful prostate cancer progression without ADT and the potential detriment to quality of life and cardiac health with ADT. We saw at ASTRO 2022 an exciting—and theoretically easily-accessible (sans genomic testing)—tool to better prognosticate the risk of distant mets using AI-assessed!http://quadshotnews.blogspot.com/2022/10/a-discerning-ai.html/link> digitized prostate biopsy slides paired with clinical data. This similar strategy takes the concept one step further using the same tools to create models that specifically predict benefit from the addition of ADT. In the end, one-third of patients were predicted to benefit with a number needed to treat of 10 to prevent one from developing distant mets within 15 years. Among the remaining two-thirds not predicted to benefit, there was in fact no discernible benefit with the addition of ADT. | Spratt, NEJM Evid 2023
