Adding 6 months of androgen deprivation therapy (ADT) to dose-escalated radiation therapy (RT) does not provide an overall survival advantage in patients with intermediate-risk prostate cancer, but it does offer oncologic benefits, according to a study published in the Journal of Clinical Oncology.
The study showed that 6 months of ADT reduced the risk of prostate-specific antigen (PSA) relapse, distant metastasis, and prostate cancer-specific mortality.
The study (Clinicaltrials.gov Identifier: NCT00936390) included 1492 prostate cancer patients with stage T2b-T2c disease, a Gleason score of 7, or a PSA of 10-20 ng/mL.
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The patients were randomly assigned to dose-escalated RT alone (arm 1) or with short-term ADT (arm 2). ADT involved 6 months of a luteinizing hormone-releasing hormone agonist or antagonist plus the antiandrogen bicalutamide or flutamide. RT modalities were external-beam RT alone to 79.2 Gy or external-beam RT to 45 Gy with brachytherapy boost.
The 5-year overall survival estimates for arms 1 and 2 were 90% and 91%, respectively, a nonsignificant difference between the groups.
However, the addition of short-term ADT significantly reduced the risk of PSA relapse by 48%, distant metastasis by 75%, and prostate cancer-specific mortality by 90%. In addition, patients who received ADT had a 38% lower risk of requiring salvage ADT.
Adverse event rates were significantly higher with ADT than without it (69% vs 21%). Acute grade 3 or higher adverse events occurred in 12% of the ADT group and 2% of the RT-only group.
A companion study of the same patient population was designed to examine quality of life. The ADT group reported clinically meaningful declines in hormonal and sexual quality of life over the short term, but these effects diminished by 1 year.
The investigators found no between-group differences in fatigue and bowel or urinary symptoms. The quality of life instruments did not capture the effects of short-term ADT on bone and cardiovascular health.
Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original references for a full list of authors’ disclosures.
References
Krauss DJ, Karrison T, Martinez AA, et al. Dose-escalated radiotherapy alone or in combination with short-term androgen deprivation for intermediate-risk prostate cancer: Results of a phase III multi-institutional trial. J Clin Oncol. Published online April 27, 2023. doi:10.1200/JCO.22.02390
Movsas B, Rodgers JP, Elshaikh MA, et al. Dose-escalated radiation alone or in combination with short-term total androgen suppression for intermediate-risk prostate cancer: Patient-reported outcomes from NRG/Radiation Therapy Oncology Group 0815 randomized trial. J Clin Oncol. Published online April 27, 2023. doi:10.1200/JCO.22.02389
This article originally appeared on Renal and Urology News
