We previously reported that for men undergoing combined androgen deprivation therapy (ADT) and radiation therapy (RT) for prostate cancer, substitution of LHRH-agonists with 5-α- reductase inhibitors (5-ARIs) led to improved preservation of 6-month hormonal quality of life (hQOL). With longer term follow-up, we evaluated disease control.
In this non-randomized trial, men with unfavorable intermediate or high-risk prostate cancer, aged ≥70 years or with Charlson Comorbidity Index ≥2, were treated with RT (78-79.2 Gy in 39-44 fractions) and either oral ADT (oADT; 5-ARI with antiandrogen) or standard of care ADT (SOC; leuprolide with antiandrogen) for up to 28 months. The primary endpoint was EPIC hQOL; secondary endpoints included biochemical control and survival as well as changes in cholesterol and hemoglobin levels.
Between 2011 and 2018, 70 men were enrolled (40 in oADT; 30 in SOC). Median follow-up was 65 months [IQR 36-94]. Five-year freedom from biochemical failure for oADT and SOC was 89% versus 86%, disease free survival was 62% versus 69%, cancer-specific survival was 100% versus 96%, and overall survival was 70% versus 81% (all P>.1). Testosterone (2 mo through 3 yr) and hemoglobin levels (2 mo through 2 yr) were higher, and cholesterol levels (1 yr) were lower in the oADT groups (all P < .05).
In this non-randomized study, men treated with combined RT and oADT had better preservation of hQOL and comparable 5-year disease outcomes to men treated with SOC. Eugonadal testosterone with this approach may yield measurable benefits in cholesterol and hemoglobin levels.
Clinical genitourinary cancer. 2024 Apr 24 [Epub ahead of print]
Greeshma Rajeev-Kumar, Sean P Pitroda, Russell Z Szmulewitz, Ted Skolarus, Scott E Eggener, Stanley L Liauw
Department of Radiation and Cellular Oncology, University of Chicago, 5758 S. Maryland Ave, Chicago, IL 60637, USA., Genitourinary Oncology Program, Department of Medicine, University of Chicago, 5841 S. Maryland Ave, Chicago, IL 60637, USA., Department of Urology, University of Chicago, 5758 S. Maryland Ave, DCAM 2D, Chicago, IL 60637, USA., Department of Radiation and Cellular Oncology, University of Chicago, 5758 S. Maryland Ave, Chicago, IL 60637, USA. Electronic address: .