Use of Androgen Deprivation Therapy With Radiotherapy for Intermediate- and High-Risk Prostate Cancer Across the United States

Vol. 2 Nr. 9 Página: 1236 - 8 Data da publicação: 01/09/2016

Use of Androgen Deprivation Therapy With Radiotherapy for Intermediate- and High-Risk Prostate Cancer Across the United States
For aggressive, localized prostate cancer, the combination of androgen deprivation therapy (ADT) with radiotherapy (RT) is one of the best-studied treatments. Multiple randomized clinical trials have consistently demonstrated that adding ADT to RT improves survival.1-5 Despite this large amount of level 1 evidence, controversy remains regarding the role of ADT. There are concerns that ADT may not benefit (or may even harm) patients with comorbidities and that the survival ben- efit from ADT may be replaced by dose-escalated RT, even though the latter has never been shown to improve survival. Therefore, we examined the adoption of ADT vs dose- escalated RT across the United States.

We analyzed data for patients with intermediate-risk (n = 54 849) and high-risk (n = 41 092) prostate cancer in the National Cancer Data Base, which includes approximately 70% of patients with cancer in the United States. Risk classi- fication was per National Comprehensive Cancer Network criteria. Intermediate-risk prostate cancer is defined as those with clinical stage T2b to T2c cancer, a Gleason score of 7, or a prostate-specific antigen measurement of 10 to 20 ng/mL (conversion to micrograms per liter is 1:1). High-risk prostate cancer is defined as stage T3, a Gleason score of 8 to 10, or a prostate-specific antigen measurement greater than 20 ng/mL. All patients were treated with external beam RT without brachytherapy. The University of North Carolina institutional review board approved this study and, because deidentified patient data from the National Cancer Data Base were used, waived the need for informed patient consent.