Abstract
Background: Androgen deprivation therapy (ADT) combined with radiation therapy benefits intermediate- and high-risk prostate cancer (PC) patients. The optimal ADT duration in combination with high-dose proton beam therapy (PBT) remains unknown. Methods: Intermediate- and high-risk PC patients treated with PBT combined with ADT for various durations were analyzed retrospectively. To assess the relationship between ADT and biochemical relapse-free (bRF) rate, Cox proportional hazards models including T stage, prostate specific antigen (PSA) level, Gleason score (GS), and total radiation dose were used. Results: In the intermediate-risk PC patients (n = 520), ADT use improved bRF (HR 0.49, 95% CI 0.26–0.93; p = 0.029), especially in those with multiple intermediate-risk factors (T2b–2c, PSA 10–20 ng/mL, and GS 7). In the high-risk PC patients (n = 555), a longer ADT duration (>6 months) conferred a benefit for bRF (HR 0.54, 95% CI 0.32–0.90; p = 0.018), which was most apparent in patients with multiple high-risk factors (T3a–4, PSA > 20 ng/mL, and GS ≥ 8) treated with ADT for ≥21 months. Conclusions: Short-term (≤6 months) ADT is beneficial for intermediate-risk PC patients, but likely unnecessary for those with a single risk factor, whereas ADT for >6 months is necessary for high-risk PC patients and ADT for ≥21 months might be optimal for those with multiple risk factors in combination of high-dose PBT.
Highlights
1,200,000 people develop prostate cancer (PC) annually worldwide, with 350,000PC-related deaths per year [1]
This study demonstrated that short-term Androgen deprivation therapy (ADT) used in combination with proton beam therapy (PBT) has a benefit for improving biochemical relapse-free (bRF) among patients with intermediate-risk PC, but no additional benefit for a longer ADT
Another study showed that extending the total ADT duration from 16 to 36 weeks before and during radiation therapy (RT) did not improve the outcomes, including bRF, overall survival (OS), and PC-specific mortality (PCSM), of patients with intermediate-risk PC [17]
Summary
1,200,000 people develop prostate cancer (PC) annually worldwide, with 350,000PC-related deaths per year [1]. Several randomized trials and meta-analyses performed in the 1990s and 2000s showed a significant benefit of androgen deprivation therapy (ADT) combined with RT in terms of biochemical control and overall survival (OS) among patients with intermediate-risk and high-risk PC [4,5,6,7]. Androgen deprivation therapy (ADT) combined with radiation therapy benefits intermediate- and high-risk prostate cancer (PC) patients. The optimal ADT duration in combination with high-dose proton beam therapy (PBT) remains unknown. In the high-risk PC patients (n = 555), a longer ADT duration (>6 months) conferred a benefit for bRF (HR 0.54, 95% CI 0.32–0.90; p = 0.018), which was most apparent in patients with multiple high-risk factors (T3a–4, PSA > 20 ng/mL, and GS ≥ 8) treated with ADT for ≥21 months. Conclusions: Short-term (≤6 months) ADT is beneficial for intermediate-risk PC patients, but likely unnecessary for those with a single risk factor, Cancers 2020, 12, 1690; doi:10.3390/cancers12061690 www.mdpi.com/journal/cancers
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