Radiation therapy with ADT increases survival in early-stage PCa

Short-term androgen deprivation therapy given in combination with radiation therapy to men with early-stage prostate cancer increased their chances of living longer compared with treatment with radiation therapy alone, according to a recent multicenter study.

Benefits of the combined treatment were limited mainly to patients with intermediate-risk disease and were not seen for men with low-risk prostate cancer, reported the authors of the Radiation Therapy Oncology Group study, which was published in the New England Journal of Medicine (2011; 365:107-18).

The study enrolled nearly 2,000 men with low- and intermediate-risk prostate cancer and followed their health status for more than 9 years at 212 centers in the United States and Canada. All study participants had localized prostate cancer and PSA

The researchers reported a statistically significant improvement in overall survival after 10 years on the trial for participants who received short-term ADT and radiation compared with those who received radiation therapy alone (62% vs. 57% overall survival). Radiation therapy plus short-term ADT was also associated with fewer prostate cancer-related deaths compared with radiation therapy alone (8% vs. 4% for the entire study population).

"This study has important significance for clinical care," said lead author Christopher U. Jones, MD, of Radiological Associates of Sacramento in Sacramento, CA. "We now have strong scientific evidence about which patients with early-stage prostate cancer benefit from short-term ADT. This is important both for improved clinical care and the utilization of health care resources."

Among men with low-risk disease, short-term ADT produced little improvement in 10-year overall survival. It is possible that, for patients with low-risk disease, longer follow-up is required to reveal a benefit. However, given that short-term ADT has substantial quality of life consequences, and the 10-year disease-specific mortality in the radiation-alone arm for men with low-risk disease was 1%, the researchers noted that these findings do not support adding short-term ADT for low-risk prostate cancer.