Is there a benefit in continuing ADT after radiotherapy in terms of avoiding cancer progression?

The role of androgen deprivation therapy on biochemical failure and distant metastasis in intermediate-risk prostate cancer: effects of radiation dose escalation. By Ludwig et al 2015 

 

Key sentence from the paper: “…the addition of ADT to external beam radiation was associated with a significantly increased PSA-free survival in intermediate risk patients… our study did not show a benefit to giving longer than 6 months of ADT.”

 

For the full abstract, see: http://www.ncbi.nlm.nih.gov/pubmed/25885406

 

Commentary: This study followed a total of 421 patients receiving ADT of which 211 experienced biochemical failure and 38 experienced the emergence of distant metastases. The researchers showed a clear benefit in terms of survival and avoiding metastases in having adjuvant ADT. However the researchers concluded that extending adjuvant ADT beyond six months showed no additional benefit. What is so intriguing is how different this result is than from the study reviewed a few items above.

If one tries to reconcile the two studies, what is clear is that some additional ADT after primary treatments, such as radiotherapy, has clear survival benefits over having no adjuvant ADT. What we still don’t know is how long that adjuvant ADT should be to maximize both overall survival and quality of life.

 

 Ludwig MS, Kuban DA, Strom SS, Du XL, Lopez DS, Yamal JM. The role of androgen deprivation therapy on biochemical failure and distant metastasis in intermediate-risk prostate cancer: effects of radiation dose escalation. BMC Cancer. 2015;15(1):190.