Generally, it is accepted that men with prostate cancer who elect to have radiation as their primary treatment benefit from also having short-term androgen deprivation therapy (ADT).

Historically, ADT is used before beginning radiation.

In a recent extensive analysis of over 7,400 men with data from 12 international randomized trials, it has been shown that it is optimal for men to begin ADT when starting radiation. This way, most of the period of low testosterone levels is "backloaded" after radiation has been completed.

The analysis included 6,325 men who had received ADT before and during (neoadjuvant/concurrent) radiation therapy and 1,084 men who received ADT during and after (concurrent/adjuvant) undergoing RT. The median follow-up period was 10.2 years.

For men receiving prostate-only radiation, ADT occurring during and after radiation was associated with improved metastasis-free survival compared with neoadjuvant/concurrent ADT.

The exception to this finding was with men who had whole-pelvis radiation instead of radiation targeted solely to the prostate gland. Men receiving whole-pelvis radiation did not have a different result based on the sequencing of the ADT, except they did have more distant metastasis occurrence among those who had concurrent/adjuvant ADT. However, that finding should be interpreted with caution due to details on how the individual trials were structured.

CONCLUSION

The authors concluded that ADT sequencing significantly impacted clinical outcomes with a strong correlation to RT field size. They believe concurrent, and adjuvant ADT should be the standard of care where short-term ADT is indicated in combination with prostate radiation.

This study appears in the Journal of Clinical Oncology