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No Benefit From Short-Term Androgen Deprivation Added to Dose-Escalated Radiotherapy for Prostate Cancer
In a phase 3 trial, short-term androgen deprivation (STAD) did not improve the overall survival of patients with intermediate-risk prostate cancer treated with dose-escalated radiotherapy.
In this study 1492 patients were randomly assigned to receive dose-escalated radiotherapy either alone, or with STAD. Modalities of radiotherapy were external-beam radiotherapy alone, or external-beam radiotherapy with brachytherapy boost. The STAD treatment was 6 months of luteinizing hormone-releasing hormone agonist/antagonist therapy plus androgen therapy. The primary end point was overall survival with secondary end points including prostate cancer-specific mortality, non-prostate cancer-specific mortality, distant metastases, PSA failure, and rates of salvage therapy.
After a median follow-up duration of 6.3 years, the 5-year overall survival estimates were 90% in the radiotherapy alone arm and 91% in the radiotherapy plus STAD arm (hazard ratio [HR], 0.85; 95% confidence interval [CI], 0.65 to 1.11; P = .22). The arm with STAD also saw a reduction in PSA failure, prostate cancer-specific mortality, and salvage therapy use. There was no significant different in the incidence of other-cause death between the 2 arms.
The incidence of acute grade ≥3 adverse events was 2% for the radiotherapy alone arm vs 12% for the arm with STAD. The total incidence of late-grade ≥3 adverse events was 14% and 15% respectively (P = .29).
The study authors concluded that benefits from STAD such as the improvements to metastases rates, prostate cancer death, and PSA failures “should be weighed against the risk of adverse events and the impact of STAD on quality of life.”
Source:
Krauss DJ, Karrison T, Martinez AA, et al. Dose-escalated radiotherapy alone or in combination with short-term androgen deprivation for intermediate-risk prostate cancer: Results of a phase III multi-institutional trial. J Clin Oncol. Published online April 27, 2023. doi: 10.1200/JCO.22.02390
