PD08-09 META-ANALYSIS OF RADIATION THERAPY AND ANDROGEN DEPRIVATION THERAPY IN LOCALIZED PROSTATE CANCER

Abstract

You have accessJournal of UrologyProstate Cancer: Localized: Radiation Therapy (PD08)1 Sep 2021PD08-09 META-ANALYSIS OF RADIATION THERAPY AND ANDROGEN DEPRIVATION THERAPY IN LOCALIZED PROSTATE CANCER Tommy Jiang, Daniela Markovic, Jay Patel, Jesus Juarez, Martin Ma, David Shabsovich, Nicholas Zaorsky, Nicholas Nickols, Robert Reiter, David Elashoff, Matthew Rettig, Daniel Spratt, and Amar Kishan Tommy JiangTommy Jiang More articles by this author , Daniela MarkovicDaniela Markovic More articles by this author , Jay PatelJay Patel More articles by this author , Jesus JuarezJesus Juarez More articles by this author , Martin MaMartin Ma More articles by this author , David ShabsovichDavid Shabsovich More articles by this author , Nicholas ZaorskyNicholas Zaorsky More articles by this author , Nicholas NickolsNicholas Nickols More articles by this author , Robert ReiterRobert Reiter More articles by this author , David ElashoffDavid Elashoff More articles by this author , Matthew RettigMatthew Rettig More articles by this author , Daniel SprattDaniel Spratt More articles by this author , and Amar KishanAmar Kishan More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001976.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Dose escalation of radiation therapy (RT) and the addition or prolongation of androgen deprivation therapy (ADT) have been independently shown to improve long-term outcomes in randomized trials for localized prostate cancer (PCa). We sought to explore the relative benefits of RT dose intensification and concomitant ADT compared to each other as well as to the historical standard of low dose RT. METHODS: PubMed was searched for Phase III randomized, controlled trials using RT for localized PCa following PRISMA guidelines. Selected trial arms were categorized as low or high dose as well as with or without ADT (categorized as short or long-term). 74 Gy was used as the threshold for “high dose” and 8 months of ADT therapy was the threshold for long-term ADT (LTADT). Outcomes included 5-year overall survival (OS), 5-year prostate cancer specific mortality (PCSM), and 5-year incidence of distant metastases (DM). Pairwise comparisons between treatments were performed using random effects meta regression models with a Bonferroni correction, where the null hypothesis was rejected for p <0.006 with respect to OS and PCSM (9 pairwise comparisons for each) and p <0.008 with respect to DM (6 pairwise comparisons). RESULTS: Forty trials recruiting a total of 21,429 patients met our inclusion criteria. Comparisons of each treatment type are shown in Table 1. Of note, when using low dose RT as the reference, low Dose RT + LTADT showed statistical improvement in PCSM (OR: 0.34 [0.22-0.54]), and DM (OR: 0.35 [0.20-0.63]). Dose escalation alone showed no statistical improvement in any reported outcome compared to low dose RT alone. When compared together, low Dose RT + LTADT was associated with improved 5-yr PCSM (OR: 0.40 [0.25-0.64]) when compared to high Dose RT alone. Improvement in OS and DM did not reach statistical significance. Overall, there was no statistical improvement in 5-year OS comparing any of the treatment modalities. CONCLUSIONS: The results of this meta-analysis suggest the benefit of adding any ADT (STADT or LTADT) to low dose RT alone outweighs the benefits of solely intensifying radiation dose. Dose escalation alone did not demonstrate any significant improvement in OS, PCSM, or DM and appeared to be associated with worse outcomes when compared to low dose RT + LTADT. Source of Funding: N/A © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e117-e117 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tommy Jiang More articles by this author Daniela Markovic More articles by this author Jay Patel More articles by this author Jesus Juarez More articles by this author Martin Ma More articles by this author David Shabsovich More articles by this author Nicholas Zaorsky More articles by this author Nicholas Nickols More articles by this author Robert Reiter More articles by this author David Elashoff More articles by this author Matthew Rettig More articles by this author Daniel Spratt More articles by this author Amar Kishan More articles by this author Expand All Advertisement Loading ...