When it comes to ADT, that is. A few years back, a large meta-analysis found that ADT during and after prostate radiation results in a relative improvement in metastasis-free survival regardless of risk group, but men with increasing risk derive greater absolute benefit. Here’s another meta-analysis of 13 randomized trials that evaluated the effect of ADT duration on overall survival, prostate cancer specific mortality, and other-cause mortality. As in the prior analysis, longer ADT resulted in a continual decrease in the risk of PCSM, and that relative benefit was not distinct between risk groups. However, the benefit ADT was nonlinear over time with little absolute benefit beyond 12 months (even in high risk patients). In addition, the risk of other-cause mortality steadily increased with prolonged ADT. The steady increase in OCM risk as incremental PCSM benefit decreases beyond 12 months is a likely reason there is little observed benefit in increasing ADT duration beyond 18 months. The authors encourage using patient PCSM and OCM risk to individualize ADT duration. | Zaorsky, JAMA Oncol 2025
