Duration of androgen suppression in the treatment of locally advanced prostate cancer
Radiotherapy plus short-term androgen suppression provides inferior survival as compared with radiotherapy plus long-term suppression
The combination of radiotherapy plus long-term medical suppression of androgens (≥ 2 years) improves overall survival in patients with locally advanced prostate cancer. Dr Michel Bolla of the Department of Radiation Oncology, Grenoble University Hospital, France and colleagues from the European Organization for Research and Treatment of Cancer (EORTC) Radiation Oncology Group and Genito-Urinary Tract Cancer Group compared the use of radiotherapy plus short-term androgen suppression with the use of radiotherapy plus long-term androgen suppression in the treatment of locally advanced prostate cancer. Study results are published in June 11, 2009 issue of The New England Journal of Medicine.
The EORTC investigators randomly assigned patients with locally advanced prostate cancer who had received external-beam radiotherapy plus 6 months of androgen suppression to two groups, one to receive no further treatment (short-term suppression) and the other to receive 2.5 years of further treatment with a luteinizing hormone–releasing hormone agonist (long-term suppression). An outcome of noninferiority of short-term androgen suppression as compared with long-term suppression required a hazard ratio of more than 1.35 for overall survival, with a one-sided ά level of 0.05. An interim analysis showed futility, and the results are presented with an adjusted one-sided ά level of 0.0429.
A total of 1113 men were registered, of whom 970 were randomly assigned, 483 to short-term suppression and 487 to long-term suppression. After a median follow-up of 6.4 years, 132 patients in the short-term group and 98 in the long-term group had died; the number of deaths due to prostate cancer was 47 in the short-term group and 29 in the long-term group. The 5-year overall mortality for short-term and long-term suppression was 19.0% and 15.2%, respectively. Adverse events in both groups included fatigue, diminished sexual function, and hot flushes.
The authors concluded that combination of radiotherapy plus 6 months of androgen suppression provides inferior survival as compared with radiotherapy plus 3 years of androgen suppression in the treatment of locally advanced prostate cancer.
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