Survival improved by RT in addition to ADT for high-risk prostate cancer
MedWire News: A combination of androgen deprivation therapy (ADT) plus radiotherapy (RT) should be the standard approach to treating high-risk prostate cancer, say researchers.
Their study shows that patients with locally advanced disease, who are therefore at high-risk for disease progression, have better overall and disease-specific survival rates if they are treated with ADT plus RT as opposed to RT-alone.
"This study is practice-changing," commented lead study author Malcolm Mason (Cardiff University, Wales, UK), adding that the findings demonstrate the benefits of radiation in high-risk patients.
"It shows that the standard treatment… should now be hormone therapy plus radiation," he said.
A total of 1205 men took part in the study, all of whom had either stage T3-4 disease (n=1057), stage T2 disease with a prostate-specific antigen (PSA) level of more than 40 µg/l (n=119), or stage T2 disease with a PSA of more than 20 µg/l and a Gleason score of 8 or higher (n=25).
Participants were randomly assigned to receive lifelong ADT treatment alone (n=602), or ADT with RT (n=603). After a median of 6 years follow-up, 320 patients had died (ADT=175, ADT plus RT=145), 140 (ADT=89, ADT plus RT=51) of whom died from prostate cancer or prostate cancer treatment specifically.
Multivariate analysis revealed that patients in the ADT plus RT group had a significant 23% reduced risk for death overall compared with the ADT-only group. Those receiving ADT plus RT also had a 43% reduced risk for disease-specific death compared with ADT-only patients.
The researchers note that longer follow-up is ongoing, but if these figures are replicated in the final analysis, "this would translate into a reduction in the chances of deaths from prostate cancer in many thousands of men worldwide," remarked Mason.
The estimated 10-year disease-specific death rates also reflected improvements for the men who received ADT plus RT compared with RT alone, at 15% versus 23%.
Finally, there was no significant difference between either treatment group in the numbers of men reporting Grade 2 or higher late gastrointestinal toxicities, with proctitis rates of 1.3% versus 1.8% among ADT and ADT plus RT patients, respectively.
The research team presented their results today at the 52nd Annual Meeting of the American Society for Radiation Oncology in San Diego, California, USA.
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By Sarah Guy