Men with locally advanced prostate cancer (without spread) who receive radiotherapy (RT) on top of their androgen deprivation therapy (ADT) have greater overall survival compared with men on ADT alone, according to Dr Padraig Warde, Radiation Medicine Programme, Princess Margaret Hospital, Toronto, Canada, Matthew R Sydes, MRC Clinical Trials Unit, London, UK, and Dr Malcolm Mason, Cardiff University School of Medicine, Wales, and colleagues.
The advantages of combined treatment, they conclude in their article published Online First by The Lancet, should be discussed with all men with this condition. This trial, the first that has been adequately powered to compare these two treatment strategies, assessed patients with locally advanced (T3 or T4) prostate cancer (n=1057); or organ-confined disease (T2) with either a prostate-specific antigen (PSA) concentration more than 40 ng/mL (n=119) or PSA concentration more than 20 ng/mL and a Gleason score of 8 or higher (n=25) Patients were randomly assigned to receive lifelong ADT and RT, or ADT only.1,205 patients were randomly assigned (602 in the ADT onlygroup and 603 in the ADT andRT group); median follow-upwas six years. At the time of analysis, a total of 320 patients had died, 175 in the ADT only group and 145 in the ADT and RT group. The addition of RT to ADT improved overall survival at seven years (74% ADT/RT vs. 66% ADT). Serious long-term genitourinary or gastrointestinal toxicity from RT was uncommon and low numbers of serious adverse events were recorded in each group.
‘This trial provides convincing evidence that local control of disease in the prostate improves survival in patients with locally advanced prostate cancer,’ the authors say, concluding: ‘Our findings suggest that the benefits of the combination of ADT and RT should be discussed with all patients considering a curative treatment approach.’