Androgen deprivation plus radiotherapy for localized prostate cancer

January 01, 0001

Androgen deprivation plus radiotherapy for localized prostate cancer

From 1994 through 2001, these US and Canadian investigators randomly assigned 1979 eligible patients with stage T1b, T1c, T2a, or T2b prostate adenocarcinoma and a prostate-specific antigen (PSA) level of 20 ng per milliliter or less to radiotherapy alone (992 patients) or radiotherapy with 4 months of total androgen deprivation treatment (ADT) starting 2 months before radiotherapy (radiotherapy plus short-term ADT, 987 patients).

They found: "The median follow-up period was 9.1 years. The 10-year rate of overall survival was 62% among patients receiving radiotherapy plus short-term ADT (the combined-therapy group), as compared with 57% among patients receiving radiotherapy alone. The addition of short-term ADT was associated with a decrease in the 10-year disease-specific mortality from 8% to 4%. Biochemical failure, distant metastases, and the rate of positive findings on repeat prostate biopsy at 2 years were significantly improved with radiotherapy plus short-term ADT. Acute and late radiation-induced toxic effects were similar in the two groups. The incidence of grade 3 or higher hormone-related toxic effects was less than 5%. Reanalysis according to risk showed reductions in overall and disease-specific mortality primarily among intermediate-risk patients, with no significant reductions among low-risk patients."

The authors concluded: "Among patients with stage T1b, T1c, T2a, or T2b prostate adenocarcinoma and a PSA level of 20 ng per milliliter or less, the use of short-term ADT for 4 months before and during radiotherapy was associated with significantly decreased disease-specific mortality and increased overall survival. According to post hoc risk analysis, the benefit was mainly seen in intermediate-risk, but not low-risk, men."

Androgen deprivation treatment should be standard for the specific group of men with prostate cancer who choose radiotherapy.

For the full abstract, click here.

N Engl J Med 365:107-118, 14 July 2011 © 2011 to the Massachusetts Medical Society
Radiotherapy and Short-Term Androgen Deprivation for Localized Prostate Cancer. Christopher U. Jones, Daniel Hunt, David G. McGowan, et al. Correspondence to Dr. Jones: [email protected]

Category: Y. Male Genital System, Breast. Keywords: prostate cancer, radiotherapy, androgen deprivation, survival, randomized controlled trial, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 2 August 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.

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