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Androgen-Deprivation Therapy Use and Duration in Postoperative Patients with Prostate Cancer
Radiotherapy (RT) combined with androgen-deprivation therapy (ADT) has long been the established standard of care for treating patients with localized or locally advanced prostate cancer. However, in men with biochemical failure after prostatectomy, the role of this combination is less well established. To learn more, investigators conducted RADICALS-HD, an international, multicenter study of post-prostatectomy patients with PSA values less than 5 ng/mL and no metastatic disease on bone scan or computed tomography.
Although the study was designed as a three-way randomization of patients receiving RT, the researchers later chose to separately evaluate two comparisons: RT alone versus RT plus short-course ADT (SC-ADT; 6 months), and RT plus SC-ADT versus RT plus long-course ADT (LC; 24 months). Each study randomized approximately 1500 patients, with a median age of about 66, median PSA values of 0.21 to 0.23, and median follow-up of 9 years.
In the first comparison, 10-year metastasis-free survival (MFS) was 79% in the RT-only group and 80% in the RT+SC-ADT group. Toxicity of grade 3 or higher was observed in 17% of the RT-only group and 14% of the RT+SC-ADT group.
In the second comparison, 10-year MFS was 72% in the RT+SC-ADT group and 78% in the RT+LC-ADT group, indicating a significant difference. Toxicity of grade 3 or higher was observed in 14% of the RT+SC-ADT group and 19% of the RT+LC-ADT group.
No treatment-related deaths occurred.
Comment
These reports from RADICALS-HD add important data to help clinicians make therapy recommendations for patients with post-prostatectomy biochemical failure. The authors state that the comparison of SC-ADT versus no ADT failed to support SC-ADT in this population. However, editorialists conclude that most patients without large competing risks of death might benefit from the addition of SC-ADT to salvage radiotherapy based on improvement in clinical progression and the avoidance of subsequent salvage ADT. Although MFS findings slightly favored LC-ADT over SC-ADT, clinicians and patients need to consider the risks for ADT-related toxicities in decision making.
Citation(s)
Author:
Parker CC et al.
Title:
Adding 6 months of androgen deprivation therapy to postoperative radiotherapy for prostate cancer: A comparison of short-course versus no androgen deprivation therapy in the RADICALS-HD randomised controlled trial.
Source:
Lancet
2024
Jun
1; [e-pub].
(Abstract/FREE Full Text)
Author:
Parker CC et al.
Title:
Duration of androgen deprivation therapy with postoperative radiotherapy for prostate cancer: A comparison of long-course versus short-course androgen deprivation therapy in the RADICALS-HD randomised trial.
Source:
Lancet
2024
Jun
1; [e-pub].
(Abstract/FREE Full Text)
Author:
Pollack A and Pra AD.
Title:
Androgen deprivation therapy combined with postoperative radiotherapy for prostate cancer management.
Source:
Lancet
2024
Jun
1; [e-pub].
(Abstract/FREE Full Text)
Empfohlen von
Robert Dreicer, MD, MS, MACP, FASCO