Department of Radiation Oncology, Fox Chase Cancer Center; Department of Biostatistics, Radiation Therapy Oncology Group, Philadelphia, PA.

Northeast Radiation Oncology Center, Scranton, PA; Department of Radiation Oncology, McGill University, Montréal, Québec; Department of Radiation Oncology, University of Western Ontario, London, Ontario, Canada; Department of Pathology, Indiana University, Indianapolis, IN; Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI; Department of Radiation Oncology, Radiological Associates of Sacramento, Sacramento, CA; Department of Radiation Oncology, University of Michigan, Ann Arbor, MI; and the Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA.

To determine whether adding 2 years of androgen-deprivation therapy (ADT) improved outcome for patients electively treated with ADT before and during radiation therapy (RT).

Prostate cancer patients with T2c-T4 prostate cancer with no extra pelvic lymph node involvement and prostate-specific antigen (PSA) less than 150 ng/mL were included. All patients received 4 months of goserelin and flutamide before and during RT. They were randomized to no further ADT (short-term ADT [STAD] + RT) or 24 months of goserelin (long-term ADT [LTAD] + RT). A total of 1,554 patients were entered. RT was 45 Gy to the pelvic nodes and 65 to 70 Gy to the prostate. Median follow-up of all survival patients is 11.31 and 11.27 years for the two arms.

At 10 years, the LTAD + RT group showed significant improvement over the STAD + RT group for all end points except overall survival: disease-free survival (13.2% v 22.5%; P < .0001), disease-specific survival (83.9% v 88.7%; P = .0042), local progression (22.2% v 12.3%; P < .0001), distant metastasis (22.8% v 14.8%; P < .0001), biochemical failure (68.1% v 51.9%; P LTAD as delivered in this study for the treatment of locally advanced prostate cancer is superior to STAD for all end points except survival. A survival advantage for LTAD + RT in the treatment of locally advanced tumors with a Gleason score of 8 to 10 suggests that this should be the standard of treatment for these high-risk patients.

Written by
Horwitz EM, Bae K, Hanks GE, Porter A, Grignon DJ, Brereton HD, Venkatesan V, Lawton CA, Rosenthal SA, Sandler HM, Shipley WU.

Reference
J Clin Oncol. 2008 Apr 14. Epub ahead of print.

PubMed Abstract
PMID:18413638

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