Androgen deprivation therapy use and duration with definitive radiotherapy for localised prostate cancer: an individual patient data meta-analysis

Kishan, Amar U.; Sun, Yilun; Hartman, Holly; Pisansky, Thomas M.; Bolla, M.; Neven, Anouk; Steigler, Allison; Denham, James W.; Feng, Felix Y.; Zapatero, A.; Armstrong, John G.; Nabid, Abdenour; Carrier, Nathalie; Souhami, Luís; Dunne, Mary; Efstathiou, Jason A.; Sandler, Howard M.; Guerrero, A.; Joseph, David; Maingon, P.; Reijke, Theo M. de; Maldonado, X.; Martin, Ting; Romero, Tahmineh; Wang, Xiaoyan; Rettig, Matthew B.; Reiter, Robert E.; Zaorsky, Nicholas G.; Steinberg, Michael L.; Nickols, Nicholas G.; Jia, Angela Y.; García, Jorge A.; Spratt, Daniel E.

doi:10.1016/s1470-2045(21)00705-1

Cited by 77 publications

(37 citation statements)

References 47 publications

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“…As a subgroup analysis, PSA response, bPFS and DMFS in (metachronous as well as repeat) oligorecurrent HSPC was evaluated. Two phase II RCT’s compared SABR to surveillance in the setting of metachronous oligorecurrent HSPC detected on choline PET-CT ( 3 ) or conventional CT and bone scintigraphy ( 4 , 10 ), showing an advantage for MDT in terms of ADT-free survival and PFS. Despite 77% of our patients having PSMA PET-selected OMD, a more sensitive selection method than conventional CT, bone scintigraphy or choline PET-CT ( 11 ), our data do not compare as favorable as those reported in the aforementioned trials.…”

Section: Discussionmentioning

confidence: 99%

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Survival Outcomes and Pattern of Relapse After SABR for Oligometastatic Prostate Cancer

et al. 2022

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IntroductionThe addition of stereotactic ablative radiotherapy (SABR) to standard of care for patients with oligometastatic prostate cancer has the potential of improving survival and delaying further metastases. The primary aim of this analysis is to report survival outcomes and pattern of recurrence of patients with hormone-sensitive (HSPC) and castrate-resistant (CRPC) oligometastatic prostate cancer treated with SABR.MethodsThis is a single-center retrospective study of patients with oligometastatic prostate cancer treated in Iridium Network between 2014 and 2018. All patients with oligometastatic (≤3 active lesions) HSPC and CRPC treated with SABR were included. Data were collected using electronic records. Patterns of first progression following SABR were reported. Kaplan-Meier methods were used to determine survival outcomes.ResultsEighty-seven men received SABR to 115 metastases. Nineteen patients were castrate-resistant and 68 hormone-sensitive at the time of SABR. Median follow-up was 41.6 months. In 25% of patients, no decline from baseline PSA was recorded. Median bPFS was 11.7 months (95% CI 7.6 - 18.3) for HSPC as well as CRPC (95% CI 6.4 - 24.0) (p=0.27). Median DMFS was 21.8 (95% CI 16.9 - 43.2) versus 17.6 months (95% CI 6.7 - 26.2) for HSPC versus CRPC, respectively (p=0.018). Median OS was 72.6 months (95% CI 72.6 – not reached) for HSPC and not reached for CRPC (95% CI 35.4 months – not reached) (p=0.026). For the subgroup of oligorecurrent HSPC, short-term androgen-deprivation therapy was associated with improved bPFS (median 6.0 vs. 18.3 months, HR 0.31, p<0.001) and DMFS (median 15.8 vs 29.6 months, HR 0.5, p=0.06). Information on pattern of relapse was retrieved for 79 patients: 45% (36/79) of these patients were long-term disease-free (>18 months), 28% (22/79) of patients wmere oligoprogressive (≤3 new lesions) and 27% (21/79) developed a polymetastatic relapse.ConclusionIn this cohort, oligometastatic HSPC showed potential benefit from SABR with a median DMFS of 21.8 months. Well-selected patients with oligometastatic CRPC may also benefit from SABR. For patients with metachronous and repeat oligorecurrent HSPC, combining SABR with short-term androgen-deprivation therapy was associated with improved bPFS and DMFS. Overall, 36/87 (41%) of patients were still free from clinical relapse at 18 months.

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Section: Discussionmentioning

confidence: 99%

“…The main goal of this approach remains to postpone the start of lifelong ADT. Adding temporary hormonal treatment has already demonstrated improved LC, OS and MFS in primary treatment of high risk PCa ( 10 ).…”

Section: Discussionmentioning

confidence: 99%

Survival Outcomes and Pattern of Relapse After SABR for Oligometastatic Prostate Cancer

et al. 2022

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Section: Guideline Statementsmentioning

confidence: 99%

“…The benefit of hormonal therapy was also demonstrated in the recently published MARCAP meta-analysis, which demonstrated that the addition of ADT to radiotherapy significantly improved metastasis-free survival (HR 0.83, 95% CI 0.77 to 0.89, p <0.0001). 33 With regard to the duration of ADT with radiation in unfavorable intermediate-risk disease, multiple clinical trials have assessed very short course ADT (eight weeks to three months) versus standard short course ADT (six months) in intermediate-risk disease, some of which have demonstrated that the six-month approach had superior cancer outcomes, including all-cause mortality and/or prostate cancerspecific mortality. 34e39 Nevertheless, the Panel acknowledges that a four-month course of ADT is also commonly given to patients with radiation therapy for intermediate-risk disease in an effort to mitigate the deleterious effects of ADT while maintaining the benefit of combination therapy for cancer control.…”

Section: Guideline Statementsmentioning

confidence: 99%

Clinically Localized Prostate Cancer: AUA/ASTRO Guideline. Part III: Principles of Radiation and Future Directions

Eastham

Auffenberg²,

Barocas

et al. 2022

Journal of Urology

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Purpose:The summary presented herein represents Part III of the three-part series dedicated to Clinically Localized Prostate Cancer: AUA/ASTRO Guideline, discussing principles of radiation and offering several future directions of further relevant study in patients diagnosed with clinically localized prostate cancer. Please refer to Parts I and II for discussion of risk assessment, staging, and risk-based management (Part I), and principles of active surveillance and surgery and follow-up (Part II).Materials and Methods:The systematic review utilized to inform this guideline was conducted by an independent methodological consultant. A research librarian conducted searches in Ovid MEDLINE, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews. The methodology team supplemented searches of electronic databases with the studies included in the prior AUA review and by reviewing reference lists of relevant articles.Results:The Clinically Localized Prostate Cancer Panel created evidence- and consensus-based guideline statements to aid clinicians in the management of patients with clinically localized prostate cancer. Statements regarding management of patients using radiation therapy as well as important future directions of research are detailed herein.Conclusions:This guideline aims to inform clinicians treating patients with clinically localized prostate cancer. Continued research and publication of high-quality evidence from future trials will be essential to further improve care for these men.

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“…This said, we would like to suggest that 2 additional issues cannot unfortunately be picked up by these retrospective analyses based on large population-based data sets: the impact of adjuvant radiation and hormonal therapy following radical prostatectomy and the type and duration of hormonal therapy administered with radiation therapy. 2 Indeed, we are all aware that among practicing urologists and radiation oncologists there is a significant variation in the multimodal treatment of high-risk and very high-risk prostate cancer patients, 3 and it would be interesting to answer the research question posed by the authors in patients managed by strictly following guidelines.…”

mentioning

confidence: 99%

Survival after Radical Prostatectomy versus Radiation Therapy in High-Risk and Very High-Risk Prostate Cancer. Letter.

et al. 2022

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Androgen deprivation therapy use and duration with definitive radiotherapy for localised prostate cancer: an individual patient data meta-analysis

Cited by 77 publications

References 47 publications

Survival Outcomes and Pattern of Relapse After SABR for Oligometastatic Prostate Cancer

Survival Outcomes and Pattern of Relapse After SABR for Oligometastatic Prostate Cancer

Clinically Localized Prostate Cancer: AUA/ASTRO Guideline. Part III: Principles of Radiation and Future Directions

Survival after Radical Prostatectomy versus Radiation Therapy in High-Risk and Very High-Risk Prostate Cancer. Letter.

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