Optimal Sequencing of ADT and RT for Low PSA Prostate Cancer Probed

Men with higher-grade localized prostate cancer and low PSA might have less hormone-responsive disease that benefits from upfront radiation therapy, study findings suggest.

For patients with unfavorable intermediate-risk or high-risk prostate cancer and a PSA of 5 ng/mL or less, concurrent androgen deprivation therapy (ADT) and upfront radiation therapy (RT) are associated with better survival than neoadjuvant ADT and RT, according to preliminary data presented at the virtual 2021 Genitourinary Cancers Symposium.

Using the National Cancer Database, investigators identified 2393 contemporary patients, of whom 2103 received neoadjuvant ADT 2 to 4 months before RT and 290 received concurrent ADT within 7 days of RT.

A multivariable analysis showed that concurrent ADT was significantly associated with a 42% lower risk for death from any cause compared with neoadjuvant ADT, Neal Andruska, MD, PhD, of the Washington University School of Medicine in St Louis, Missouri, and colleagues reported. Patients with Gleason 4 or 5 disease who received concurrent ADT had a significant 69% lower mortality risk.

Treatment at an academic center was significantly associated with a 29% lower death risk. Increasing age, however, was significantly associated with worsening survival. The time lapse from diagnosis to RT initiation showed no relationship.

During the COVID-19 pandemic, there has been greater interest in neoadjuvant ADT as a way to delay initiation of RT to reduce risk of COVID-19 transmission from daily healthcare visits, Dr Andruska’s team noted. It is unclear if neoadjuvant ADT is appropriate for all patients or if select cohorts may benefit from concurrent ADT and upfront RT, such as patients with higher-grade disease and low PSA who may have less hormone-responsive disease, they stated. The current study findings support the latter, but require validation in a randomized trial.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Andruska N, Agabalogun T, Fischer-Valuck BW, et al. Neoadjuvant versus concurrent androgen deprivation therapy plus radiotherapy for unfavorable intermediate-risk and high-risk prostate cancer with low PSA. Paper presented at the 2021 Genitourinary Cancers Symposium; February 2021. Abstract 243.