Optimal duration of androgen deprivation therapy following radiation therapy in intermediate- or high-risk non-metastatic prostate cancer: A systematic review and meta-analysis

Abstract

Objectives:To investigate current evidence on the optimal duration of adjuvant hormone deprivation for prostate cancer treated with radiation therapy with curative intent.Materials and Methods:A systematic search was performed in electronic databases. Data from randomized trials comparing different durations of hormone blockade was collected for pooled analysis. Overall survival, disease-free survival, disease-specific survival and toxicity were the outcomes of interest. Meta-analyses were performed using random-effects model.Results:Six studies met the eligibility criteria. For overall survival, the pooled data from the studies demonstrated a statistically significant benefit for longer hormone deprivation (Hazard Ratio 0.84; 95% CI 0.74 – 0.96). A statistically significant benefit was also found for disease-free survival (Hazard Ratio 0.74; 95% CI 0.62 – 0.89), and disease-specific survival (Hazard Ratio 0.73; 95% CI 0.62 – 0.85). Studies with longer blockade duration arm demonstrated greater benefit. Toxicity was low, with no increase in cardiovascular events.Conclusions:Longer duration of androgen deprivation combined to radiotherapy prolongs OS, DFS and DSS in patients with intermediate and high-risk non-metastatic prostate cancer. However, this evidence is based on trials using older radiation techniques, and further research of combination of androgen deprivation and new RT technologies may be warranted.

Harnessing the potential of multimodal radiotherapy in prostate cancer

“…[H2]Radiotherapy combined with ADT Androgens promote prostate cancer cell proliferaNon (102,103); thus, ADT is a keystone of prostate cancer therapy. ADT is given concomitantly with radiotherapy, most commonly as neoadjuvant therapy, and then conNnuing during and beyond radiotherapy, although the Nming and duraNon of ADT is uncertain given that the available evidence is based on trials using older radiaNon techniques (104,105). The combinaNon of ADT and radiotherapy has improved treatment of prostate cancer, but Research and Treatment of Cancer (EORTC) study 22863 was the first phase 3 study to show a significant overall survival benefit of radiotherapy combined with ADT in men with locally advanced prostate cancer (112).…”

Effect of adjuvant hormone therapy in patients with prostate cancer

“…[50] Furthermore, another important meta-analysis suggested that longer duration of androgen deprivation combined with radiotherapy prolongs OS, DFS, and disease-specific survival (DSS) in patients with intermediate and high-risk nonmetastatic PCa. [51] However, this evidence is based on trials using older radiation techniques, and further research on combination of androgen deprivation, and new RT technologies may be warranted. The inherent limitation of the previous review is that the effect of AHT in several specific subpopulations was not evaluated, and the treatment effect among patients with different baseline characteristics was not compared.…”

The Use of Androgen Deprivation Therapy for Prostate Cancer Lead to Similar Rate of Following Open Angle Glaucoma: A Population-Based Cohort Study

“…Prostate cancer is a major malignancy in the male population [1], with more than 160,000 new patients diagnosed annually in the United State [2]. For treatment, androgen deprivation therapy (ADT) has been applied for decades which can reduce the function of prostate and suppress the progression of prostate cancer [1,3,4]. The treatment options of prostate cancer include the LHRH agonists, antiandrogens, estrogens and orchiectomy [5].…”