Short V. Long-Term Androgen Suppression Plus External Beam Radiation Therapy And Survival In Men Of Advanced Age With High-Risk Adenocarcinoma

Main Category: Prostate / Prostate Cancer
Also Included In: Endocrinology;  Radiology / Nuclear Medicine;  Clinical Trials / Drug Trials
Article Date: 03 Jun 2007 - 0:00 PDT

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UroToday.com- Since the well-conducted prospective randomized trials of the EORTC and RTOG patients with high-risk prostate cancer managed with external beam radiotherapy have been treated with 2 to 3 years of androgen deprivation therapy (ADT). Recently however, heightened awareness about the metabolic and cardiovascular consequences of ADT has brought into question whether a shorter course of ADT may be sufficient.

In the May 15th issue of Cancer, D'Amico, Denham, Bolla, and colleagues present pooled data from 3 randomized trials analyzing whether the length of ADT matters in elderly men treated with radiotherapy. A total of 311 men were identified who had received radiotherapy with 6 months or 3 years of ADT. The median age was 70 years with a median follow-up of almost 6 years. All men had node-negative locally advanced prostate cancer (T3 or T4) of any Gleason score or clinical stage T1-T2 cancer with Gleason score 8-10.

After adjusting for confounding clinical and pathologic variables receiving 3 years of androgen deprivation was not associated with a significant decrease in mortality compared with men who received 6 months of ADT (hazard ratio = 1.1, 95% CI 0.7 to 1.8). There was also no difference in the subset of patients with Gleason 8 to 10 tumors although it nearly approached statistical significance (HR = 1.6, 95% CI 0.9 to 2.6, p = 0.09).

These pooled data evaluated in a retrospective fashion with a small number of patients suggest that using 6 months of ADT may be equivalent to 3 years of therapy in elderly men treated with radiotherapy for high-risk prostate cancer. As suggested by the authors, these results may be explained by the fact that elderly men treated with 6 months of ADT may continue with castrate testosterone levels for as long as 2 years after therapy. We anxiously await the results of the next EORTC trial designed to answer this question in a larger cohort of patients treated in a prospective fashion.

D'Amico A.V, Denham J. W, Bolla M, Collette L, Lamb D.S, Tai K.H, Steigler A, Chen M.H

Cancer. 109(10):2004-10, May 15, 2007.
Reported by UroToday.com Contributing Editor Ricardo F. Sánchez-Ortiz, MD

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