ADT in men with node-positive prostate cancer treated with postoperative radiotherapy.

[pjoshea13]

New Italian/Sloan Kettering study below [1].

"In men with node-positive prostate cancer after radical prostatectomy there are limited data on the value of adding androgen deprivation therapy (ADT) to postoperative radiotherapy."

"Patients who received postoperative radiotherapy + ADT had more aggressive disease, with higher preoperative PSA level, higher rate of ISUP grade 5, pT3b-T4 tumors and ≥3 positive nodes. ..."

"... the comparison between men treated by postoperative radiotherapy + ADT vs. radiotherapy alone did not show a significant difference for overall ... and cancer-specific survival ..."

These results ... suggests that a clinically significant benefit of ADT in node-positive patients receiving radiotherapy after surgery is unlikely."

"We can exclude the sort of large survival benefit that would be required to justify the risks and toxicities of ADT in men with node-positive disease receiving postoperative radiotherapy."

-Patrick

ncbi.nlm.nih.gov/pubmed/316...

Urol Oncol. 2019 Oct 22. pii: S1078-1439(19)30369-2. doi: 10.1016/j.urolonc.2019.09.018. [Epub ahead of print]

Androgen deprivation therapy in men with node-positive prostate cancer treated with postoperative radiotherapy.

Bravi CA1, Tin A2, Vertosick E2, Mazzone E3, Bandini M3, Dell'Oglio P3, Stabile A3, Gandaglia G3, Fossati N3, Sjoberg D2, Touijer K4, Cozzarini C5, Briganti A3, Montorsi F3, Eastham J4, Vickers A2.

Author information

1

Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy; Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY. Electronic address: [e-mail].

2

Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY.

3

Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy.

4

Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.

5

Department of Radiotherapy, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy.

Abstract

BACKGROUND:

In men with node-positive prostate cancer after radical prostatectomy there are limited data on the value of adding androgen deprivation therapy (ADT) to postoperative radiotherapy.

OBJECTIVE:

To determine whether there is a clear oncologic benefit to ADT in the setting of node-positive prostate cancer treated with postoperative radiotherapy.

METHODS:

We analyzed data for 372 prostate cancer patients treated at San Raffaele Hospital with postoperative radiotherapy for node-positive disease after radical prostatectomy, 272 received both ADT and radiotherapy. Eighty-six men were followed without an event for more than 10 years.

RESULTS:

Patients who received postoperative radiotherapy + ADT had more aggressive disease, with higher preoperative PSA level, higher rate of ISUP grade 5, pT3b-T4 tumors and ≥3 positive nodes. At multivariable Cox regression, the comparison between men treated by postoperative radiotherapy + ADT vs. radiotherapy alone did not show a significant difference for overall (hazards ratio: 0.91; 95% confidence interval: 0.45, 1.84; P = 0.8) and cancer-specific survival (hazards ratio: 5.39; 95% confidence intervalI: 0.70, 41.39; P = 0.11). These results remained consistent in a number of sensitivity analyses, including propensity score matching. Consideration of 95% CIs suggests that a clinically significant benefit of ADT in node-positive patients receiving radiotherapy after surgery is unlikely.

CONCLUSIONS:

We can exclude the sort of large survival benefit that would be required to justify the risks and toxicities of ADT in men with node-positive disease receiving postoperative radiotherapy. Awaiting larger and more powered studies on this topic, men with pN+ prostate cancer treated with postoperative radiotherapy should not receive ADT outside well-controlled clinical trials.

Copyright © 2019 Elsevier Inc. All rights reserved.

KEYWORDS:

Androgen deprivation therapy; Node-positive prostate cancer; Postoperative radiotherapy; Radical prostatectomy

PMID: 31653565 DOI: 10.1016/j.urolonc.2019.09.018

[AlanMeyer]

Hello Patrick,

This study raises questions but the abstract isn't clear about why some men got ADT and some didn't. It doesn't appear to have been a randomized trial, so it's possible that men with more extensive disease were the ones who got the ADT and it was not the ADT that caused the difference in outcomes. There was "propensity score matching", so maybe that adequately compensated for the selection bias, but then again maybe not.

One day in the future science will have discovered the actual biochemistry involved in all these treatments and our descendants will know whether, how, and why ADT and other treatments affect different patients differently, but I'm guessing that's quite a few decades away. In the meantime, studies like this are all we've got.

Alan