Addition of androgen deprivation therapy to PBRT halts progression of prostate cancer: Lancet
A new study published in The Lancet shows the advantage of combining short-term androgen deprivation treatment (ADT) with prostate bed radiation (PBRT) to prevent prostate cancer development.
Salvage prostate bed radiation leads to around 70% of patients being free of progression at 5 years in males with detectable prostate-specific antigen (PSA) levels following prostatectomy for prostate cancer. A three-group randomized experiment was planned and conducted by Alan Pollack and team to see if adding 4–6 months of short-term androgen deprivation treatment to PBRT, or both short-term ADT and pelvic lymph node radiation (PLNRT) to PBRT, may result in incremental increases in patient outcomes.
The SPPORT experiment was conducted at 283 radiation oncology cancer treatment centers in the United States, Canada, and Israel. It was an international, randomized, multicenter, controlled trial. Eligible patients (aged 18 years) had a consistently detectable or originally undetected and growing PSA of between 01 and 20 ng/mL following prostatectomy for prostate cancer. If there was no clinical or pathological indication of lymph node involvement, patients with and without lymphadenectomy (N0/Nx) were eligible. Other qualifying criteria were pT2 or pT3 disease, a Gleason score of 9 or less after prostatectomy, and a Zubrod performance status of 0–1. Eligible patients were randomly randomized to one of three groups: PBRT alone (group 1), PBRT plus short-term ADT (group 2), or PLNRT plus PBRT plus short-term ADT (group 3). The primary outcome was independence from progression, which was defined as biochemical failure using the Phoenix criteria, clinical failure, or death from any cause. A proposed interim analysis of 1191 patents with a minimum prospective follow-up duration of 5 years used a Haybittle-Peto threshold of p0001 (one-sided) to compare 5-year freedom from progression rates across treatment groups.
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