Should patients with prostate cancer get androgen deprivation therapy before or after radiotherapy?

This study compared the effectiveness of giving androgen deprivation therapy (ADT) before or after radiotherapy (RT) for prostate cancer (PCa). The study found that treatment with RT followed by ADT increased patient survival without the spread of the disease.

PCa can often spread to other locations within the body. One main treatment option for patients with PCa is RT. ADT is also given to try to prevent cancer growth and spread. ADT reduces the production of androgens (male sex hormones such as testosterone). Reducing these androgens prevents cancer cell growth. ADT can be given before and during RT (neoadjuvant) or during or following RT (adjuvant). However, which sequence benefits patients with PCa the most, is still unknown.

This study combined information from two clinical trials. Overall, 1065 patients with PCa were included in the study. 531 patients were given neoadjuvant ADT, followed by RT. 534 patients were given RT with adjuvant ADT. The average follow-up time was 14.9 years.

29% of the neoadjuvant group and 36% of the adjuvant group were alive without cancer progression after 15 years. Patients who received RT with adjuvant ADT had a 25% longer survival without progression of their disease. Also, the adjuvant group was 17% more likely to survive at 15 years without cancer spreading. The 15 years overall survival rate was slightly higher with adjuvant ADT (39%) compared to neoadjuvant ADT (34%).

There were no significant differences in serious genito-urinary and bowel-related side effects between the 2 groups.

This study concluded that giving patients with PCa RT with adjuvant ADT improved patient survival without progression of the disease compared to neoadjuvant ADT.

The overall analysis did not consider that the adjuvant therapy routines were slightly different between the trials.