Androgen deprivation therapy combined with postoperative radiotherapy for prostate cancer management

• Published in: The Lancet (British edition) Vol. 403; no. 10442; pp. 2353 - 2355
• Main Authors: Pollack, Alan, Pra, Alan Dal
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-06-2024; Elsevier Limited
• Subjects: Androgens; Antigens; Death; Disease management; Fatalities; Free radicals; Metastases; Metastasis; Oncology; Patients; Prostate cancer; Quality of life; Radiation therapy; Statistical analysis; Survival
• ISSN: 0140-6736; 1474-547X; 1474-547X
• DOI: 10.1016/S0140-6736(24)00802-X

Metastasis-free survival is a composite endpoint that includes development of distant metastasis and death from any cause. [...]about 45% of the metastasis-free survival events are deaths from other causes; the preponderance of deaths from other causes would contribute to the associations between metastasis-free survival and overall survival seen in ICECa8 and other reports. The higher the proportion of deaths from other (non-prostate-cancer) causes, along with the timing of those deaths (early deaths impacting more than late deaths), has the potential to reduce the ability to assess a metastasis-free survival benefit, especially in the population with more favourable risk in the no ADT versus short-course ADT comparison. Two other reported endpoints—clinical progression and the use of secondary salvage ADT—show a meaningful and statistically significant benefit from the addition of short-course ADT to radiotherapy, which should be considered along with that of the highly anticipated DADSPORT meta-analysis.9 Our view is that, for patients without significant competing risks of death, the addition of short-course ADT to salvage radiotherapy is beneficial in the majority of patients, even without confirmation of a significant metastasis-free survival improvement in RADICALS-HD. [...]evidence-based medicine is the intersection of three main factors: the use of current best available evidence, physician clinical experience, and patient or family values, all of which should contribute to trade-off considerations regarding the impact of ADT on quality of life.