Duration of ADT With Radiation After Prostatectomy Depends on Risk Factors
Posted: Monday, April 22, 2019
The optimal duration of androgen-deprivation therapy (ADT) during salvage radiation therapy after radical prostatectomy varies depending on three risk factors, according to a retrospective multisite study. The research was published in European Urology by Nicola Fossati, MD, of the IRCCS Ospedale San Raffaele in Italy, and colleagues.
“Patients with more adverse features benefit from long-term concomitant hormonal therapy. On the contrary, for patients with a single risk factor, short-term [hormonal therapy] may be reasonable,” the authors wrote.
The retrospective study included 1,264 patients treated with postprostatectomy salvage radiation therapy at 8 referral centers. Patients were sorted by number of risk factors. The risk factors were pT stage ≥ pT3b, pathologic Gleason ≥ 8, and prostate-specific antigen (PSA) level at salvage radiation therapy of > 0.5 ng/mL. Only 29% of the patients received ADT, and the median duration was 9 months. The endpoint of interest was 8-year clinical recurrence–free survival rate, identified by imaging.
The overall 8-year clinical-recurrence–free survival rate was 92%. Men with no risk factors did not benefit from ADT, men with a single risk factor benefited somewhat from up to 12 months of ADT, and men with 2 or more risk factors benefited from up to 36 months of ADT.
One study limitation is that at the time patients received treatment, there was no evidence for the best specific protocol for timing of ADT and type of ADT, so these protocols varied. Because the study was retrospective, the authors recommend a future prospective clinical trial to confirm the results.
Disclosure: The study authors reported no conflicts of interest.