Don’t omit ADT following radiotherapy

Androgen deprivation therapy (ADT) should be added to external beam radiotherapy (EBRT) in patients with localised prostate cancer and improves overall survival (OS) more than adding a brachytherapy boost (BT), according to a meta-analysis published in the Journal of Clinical Oncology.

Six trials compared EBRT with or without ADT (n = 4663), and three compared EBRT with or without BT (n = 718). The addition of ADT to EBRT improved OS (hazard ratio [HR], 0.71 [95% CI, 0.62 to 0.81]), whereas the addition of BT did not significantly improve OS (HR, 1.03 [95% CI, 0.78 to 1.36]). In a network meta-analysis, EBRT plus ADT had improved OS compared with EBRT plus BT (HR, 0.68 [95% CI, 0.52 to 0.89]).

The researchers conclude that the current practice of omitting ADT following radiotherapy in men with intermediate to high-risk prostate cancer may result in worse outcomes. ADT for these men should remain a critical component of treatment regardless of radiotherapy delivery method until randomised evidence demonstrates otherwise, they say.

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