Top Line: Who benefits from ADT and prolonged ADT with post-prostatectomy radiation?
The Study: Currently, we often personalize the use of ADT with salvage radiation for biochemically recurrent prostate cancer. Multiple trials like GETUG-AFU 16, RTOG 9601, and SPPORT have shown reduced risk of progression with the addition of ADT, but only 9601 showed a survival improvement that appeared limited to those with higher PSA. RADICALS-HD also found improved progression outcomes with long term versus short term ADT. POSEIDON was an individual patient data meta-analysis that sought to assess the benefit of adding ADT to PORT and how that benefit varies with PSA. It included 6057 patients from 6 randomized trials with 9 years median follow up. Overall, adding any ADT to PORT did not significantly improve OS overall (HR 0.87, p=0.06; 10-year OS 83.6% vs 84.3%). There was also no interaction between ADT duration and survival (short vs long, p=0.17). Metastasis free survival was improved, but the absolute benefit was small. Those with low pretreatment PSA (≤0.5 ) had no survival benefit with ADT. A survival benefit began to emerge when the PSA exceeded 0.5, but the benefit was small until the PSA exceeded 1.6-2.0. Likewise, the benefits of short vs long term ADT were similar until the PSA exceeded 1.6.
TBL: This massive meta-analysis suggests there is little survival benefit from adding ADT to early PORT for prostate cancer when the PSA is 0.5 or less. Even with a PSA above 0.5, the absolute benefit of ADT (and particularly long term ADT) is mainly seen in those with significantly elevated PSA of 1.6 or more. | Kishan, Lancet 2026
The Study: Currently, we often personalize the use of ADT with salvage radiation for biochemically recurrent prostate cancer. Multiple trials like GETUG-AFU 16, RTOG 9601, and SPPORT have shown reduced risk of progression with the addition of ADT, but only 9601 showed a survival improvement that appeared limited to those with higher PSA. RADICALS-HD also found improved progression outcomes with long term versus short term ADT. POSEIDON was an individual patient data meta-analysis that sought to assess the benefit of adding ADT to PORT and how that benefit varies with PSA. It included 6057 patients from 6 randomized trials with 9 years median follow up. Overall, adding any ADT to PORT did not significantly improve OS overall (HR 0.87, p=0.06; 10-year OS 83.6% vs 84.3%). There was also no interaction between ADT duration and survival (short vs long, p=0.17). Metastasis free survival was improved, but the absolute benefit was small. Those with low pretreatment PSA (≤0.5 ) had no survival benefit with ADT. A survival benefit began to emerge when the PSA exceeded 0.5, but the benefit was small until the PSA exceeded 1.6-2.0. Likewise, the benefits of short vs long term ADT were similar until the PSA exceeded 1.6.
TBL: This massive meta-analysis suggests there is little survival benefit from adding ADT to early PORT for prostate cancer when the PSA is 0.5 or less. Even with a PSA above 0.5, the absolute benefit of ADT (and particularly long term ADT) is mainly seen in those with significantly elevated PSA of 1.6 or more. | Kishan, Lancet 2026