Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Prostate cancer: Delaying radiotherapy after ADT not linked to poor overall survival

Publish date:: September 18, 2020

Key clinical point: Delaying radiotherapy (RT) initiation up to 6 months after androgen deprivation therapy (ADT) initiation is not associated with worse overall survival (OS) compared with initiating RT before ADT in patients with localized prostate cancer (PCa).

Major finding: The 10-year OS among men with unfavorable intermediate-risk PCa who initiated RT 0-60 days before, 1-60 days after, 61-120 days after, and 121-180 days after ADT initiation was 59.2%, 57.9%, 62.3%, and 58.9%, respectively. The 10-year OS among men with high-risk or very high-risk PCa was 58.9%, 51.7%, 54.8%, and 52.4%, respectively.

Study details: This retrospective analysis included 63,858 men diagnosed with PCa (unfavorable intermediate-risk PCa: n = 19,258; high-risk PCa: n = 44,600) using data from the National Cancer Database between 2004 and 2014.

Disclosures: This study was funded by grant from the National Institutes of Health. The corresponding author reported receiving a grant from the Conquer Cancer Foundation outside the submitted work.

Commentary

“Definitive treatment for prostate cancer is usually instituted as soon as possible. However, the COVID-19 pandemic has led to the consideration of delays in care for safety reasons. The introduction of neoadjuvant androgen deprivation therapy (ADT) prior to radiation has been studied, but the clinical situations in those studies are not fully applicable to all patients. Dee et al utilized the National Cancer Database to determine if delays in starting radiation affected outcomes in patients with intermediate-risk, high-risk, or very high-risk prostate. Patients were grouped according radiation start times ranging from 0-60 days prior to ADT initiation to 120 days after ADT initiation. No statistically significant differences in 10-year overall survival were identified in patients in either group amongst the start time ranges. While the data is retrospective, the findings provide some reassurance that necessary delays in therapy are unlikely to have large effects on outcomes in similar patients.”