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Sequencing of ADT, RT Examined in Localized Prostate Cancer

Pooled analysis of 12 randomized trials suggests use of concurrent/adjuvant androgen deprivation therapy in combination with prostate-only radiotherapy may improve outcomes

MONDAY, Oct. 31, 2022 (HealthDay News) — When short-term androgen-deprivation therapy (ADT) is indicated in combination with prostate-only radiotherapy (PORT) for localized prostate cancer, concurrent/adjuvant ADT may result in better outcomes, according to a study published online Oct. 21 in the Journal of Clinical Oncology.

Ting Martin Ma, M.D., Ph.D., from the University of California in Los Angeles, and colleagues examined the impact of ADT sequencing for men receiving ADT with PORT or whole-pelvis RT (WPRT). Individual patient data were included from 12 randomized trials with patients receiving neoadjuvant/concurrent or concurrent/adjuvant short-term ADT (four to six months) with RT for localized disease (6,325 and 1,084 men, respectively). Metastasis-free survival and overall survival were assessed by inverse probability of treatment weighted-adjusted Cox regression models analyzed for men receiving PORT versus WPRT.

The researchers found that for all end points except overall survival, there was a significant interaction observed between ADT sequencing and RT field size. With PORT, concurrent/adjuvant ADT was associated with improved metastasis-free survival (hazard ratio, 0.65), distant metastasis (subdistribution hazard ratio, 0.52), prostate cancer-specific mortality (subdistribution hazard ratio, 0.30), and overall survival (hazard ratio, 0.69) versus neoadjuvant/concurrent ADT. For patients receiving WPRT, there was no significant difference observed in any end point, apart from worse distant metastasis with concurrent/adjuvant ADT (hazard ratio, 1.57).

“To our knowledge, this study represents the first time a significant association has been demonstrated between concurrent and adjuvant ADT sequencing and overall survival rates among prostate cancer patients,” a coauthor said in a statement. “For patients receiving prostate-only RT, concurrent/adjuvant sequencing is associated with optimal outcomes.”

Several authors disclosed financial ties to the pharmaceutical industry.

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