10-year survival best after RT with ADT for prostate cancer with high metastatic risk
MedWire News: External radiotherapy (RT) plus long-term androgen deprivation therapy (ADT) significantly improves the overall survival of patients with high-metastatic-risk prostate cancer compared with radiation alone, show the results of a European trial.
Clinical disease-free survival is also improved and prostate cancer mortality is reduced in these men after combined RT plus ADT versus RT alone, report the researchers in The Lancet Oncology.
"The combination of RT and 3 years of androgen suppression... should be regarded as standard of care for treatment of men with prostate cancer who are at high metastatic risk, with a WHO [World Health Organization] performance status of 0-2, and who have no contraindicating coexisting conditions," say Michel Bolla (University Hospital, Grenoble, France) and colleagues.
For the European Organisation for Research and Treatment of Cancer (EORTC) trial, 415 patients with newly diagnosed stage T1-2 WHO grade 3, or stage T3-4 and any WHO grade cancer were randomly assigned to receive RT alone (n=208) or RT plus immediate ADT (n=207).
Patients were irradiated externally to the whole pelvis, prostate, and seminal vesicles daily, 5 days a week, for 7 weeks. Those in the combined therapy group began subcutaneous ADT on the first day of pelvic radiation and continued the treatment for 3 years.
After a median follow-up period of 9.1 years, 104 patients in the RT group had progressive disease compared with 44 patients in the combined treatment group.
This resulted in a significantly higher 10-year clinical disease-free survival rate in the combined treatment group compared with the RT-alone group, at 47.7% versus 22.7%.
RT plus ADT patients also had a 50% reduced risk for developing distant metastasis at 10 years compared with RT-alone patients.
A total of 80 deaths were registered in the RT plus ADT group (57 from prostate cancer) compared with 112 in the RT-alone group (26 from prostate cancer), resulting in an overall survival rate of 58.1% versus 39.8%, respectively, observes the research team.
For men treated with combined therapy, the risk for prostate-specific mortality was reduced by a significant 62% compared with those treated with RT alone.
Bolla and team observed no significant differences between treatment groups for cardiovascular mortality - one of the EORTC trials' outcome measures - even among men who presented with the disease before treatment.
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By Sarah Guy