Among men with unfavorable-risk prostate cancer and moderate or severe co-existing illness, long-term follow-up finds that radiation therapy alone vs radiation therapy and androgen deprivation therapy was associated with decreased overall and cardiac mortality, according to a study in the September 22/29 issue of JAMA.
Six months of androgen deprivation therapy (ADT) and radiation therapy (RT) vs RT alone prolongs survival and is the standard treatment for unfavorable-risk prostate cancer. A post-randomization analysis suggested that men with moderate or severe comorbidity (co-existing illness) had no survival benefit from combined therapy. Using updated data from this trial, Anthony V. D'Amico, M.D., Ph.D., of Brigham and Women's Hospital, Boston, and colleagues compared overall survival and mortality from prostate cancer, cardiac, or other causes in all men and those within comorbidity subgroups by treatment group. Between December 1995 and April 2001, 206 men with unfavorable-risk prostate cancer were randomly assigned to receive RT alone or RT and 6 months of ADT at 3 academic and 3 community-based centers in Massachusetts.
The researchers found that at a median follow-up of 17 years, RT alone vs RT and ADT was associated with significantly decreased overall and cardiac mortality in men with moderate or severe comorbidity. This is in contrast to no association with overall mortality at a median follow-up of 8 years. Although RT alone vs RT and ADT was associated with increased mortality in men with none or minimal comorbidity, mortality among all men assigned to RT alone was not significantly increased.
"The association of treatment with RT alone with decreased cardiac and overall mortality in men with moderate or severe comorbidity suggests that administering ADT to treat unfavorable-risk prostate cancer in these men should be carefully considered," the authors write.
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(doi:10.1001/jama.2015.8577; Available pre-embargo to the media at http:/media.jamanetwork.com)
Editor's Note: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.
Journal
JAMA