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Radiotherapy

PSA surrogates for survival with ADT

Nature Reviews Urology volume 9, page 7 (2012)Cite this article

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The addition of androgen deprivation therapy (ADT) to radiation therapy in men with localized or locally advanced prostate cancer has demonstrated clear survival benefits in several large trials. However, the slender survival advantage conferred by 3 years of ADT in comparison to just 6 months (3.8% at 5 years, according to a 2009 EORTC study) comes at an undesirable cost of treatment toxicity. In order to avoid the administration of unnecessary ADT, early identification of those men who are unlikely to be cured by radiation therapy and 6 months of ADT would be of great clinical utility. In a study published in Lancet Oncology, D'Amico and colleagues investigated whether PSA nadir or PSA level at the immediate end of treatment ('PSA end')—using a cut-off PSA level of 0.5 ng/ml in each case—can be used as surrogates for prostate-cancer-specific mortality (PCSM) in these men.

The authors analyzed individual patient data obtained from two randomized controlled trials: the Dana Farber Cancer Institute (DFCI) trial and the Trans-Tasman Radiation Oncology Group (TROG) trial. The results of both trials demonstrated improved overall and cancer-specific survival in men with localized or locally advanced prostate cancer treated with radiation therapy (66–70 Gy in 1.8–2.0 Gy fractions) and 6 months of ADT (comprising a luteinising-hormone-releasing hormone agonist plus anti-androgen) compared to radiation therapy alone. Patients were followed up every 3 months for the first 2 years, every 4–6 months for the next 3 years, and yearly thereafter. Overall, data from 734 men were included in the current analysis.

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ORIGINAL RESEARCH PAPER

  1. D'Amico, A. V. et al. Surrogate endpoints for prostate cancer-specific mortality after radiotherapy and androgen suppression therapy in men with localised or locally advanced prostate cancer: an analysis of two randomised trials. Lancet Oncol. doi:10.1016/S1470-2045(11)70295-9

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  1. Nick Warde
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Warde, N. PSA surrogates for survival with ADT. Nat Rev Urol 9, 7 (2012). https://doi.org/10.1038/nrurol.2011.209

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  • DOI: https://doi.org/10.1038/nrurol.2011.209

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