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Improved Survival Reported With Prostate Radiation Therapy Plus Androgen-Deprivation Therapy in Metastatic Prostate Cancer

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Key Points

  • Prostate radiation therapy was associated with improved survival vs androgen-deprivation therapy alone in men with newly diagnosed metastatic prostate cancer.
  • Survival with androgen-deprivation therapy plus radiation therapy ≥ 65 Gy was similar to that with androgen deprivation plus prostatectomy.

The addition of prostate external-beam radiation therapy to androgen-deprivation therapy was associated with prolonged overall survival in men with newly diagnosed metastatic prostate cancer, according to a National Cancer Database analysis reported by Rusthoven et al in the Journal of Clinical Oncology.

The analysis included 6,382 treated patients between 2004 and 2012, including 538 men (8.4%) who received prostate radiation therapy. Median follow-up was 5.1 years.

Improved Survival

On univariate analysis, the addition of prostate radiation therapy to androgen-deprivation therapy was associated with improved median overall survival (53 vs 29 months, hazard ratio [HR] = 0.562, P < .001), with improved estimated survival at 3 (62% vs 43%), 5 (49% vs 25%), and 8 years (33% vs 13%). The benefit remained significant on multivariate analysis adjusting for age, year, race, comorbidity score, prostate-specific antigen level, Gleason score, T stage, N stage, chemotherapy use, treating facility, and insurance status (HR = 0.624, P < .001).

Propensity score analysis including 1,074 patients with matched baseline characteristics also showed improved survival (median = 55 vs 37 months, HR = 0.67, P < .001). Improved survival was observed in landmark analyses among long-term survivors of ≥ 1 year (HR  = 0.55, P < .001), ≥ 3 years (HR = 0.54, P < .001), and ≥ 5 years (HR = 0.67, P = .023).

On multivariate analysis, compared with androgen-deprivation therapy alone, hazard ratios for overall survival were 1.02 (P = .874) among 163 patients also receiving radiation therapy at < 65 Gy, 0.45 (P < .001) among 324 patients also receiving radiation therapy at ≥ 65 Gy, and 0.38 (P < .001) among 69 patients also undergoing prostatectomy.

The investigators concluded: “In this large contemporary analysis, men with [metastatic prostate cancer] receiving prostate radiation therapy and [androgen-deprivation therapy] lived substantially longer than men treated with [androgen-deprivation therapy] alone. Prospective trials evaluating local therapies for [metastatic prostate cancer] are warranted.”

Chad G. Rusthoven, MD, of the University of Colorado School of Medicine, is the corresponding author of the Journal of Clinical Oncology article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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