Top Line: The decision to administer or omit short term ADT for intermediate risk prostate cancer isn’t a simple yes or no–it’s a nuanced balance between prostate cancer benefits and toxicity.
The Study: Last week, we reviewed the results of RTOG 0815, which showed no improvement in overall survival at 5 years when short term ADT was added to dose escalated radiation for intermediate risk prostate cancer. However, RTOG 0815 clearly showed that, at 8 years, ADT reduced biochemical recurrence (10% v 21%), distant metastasis (1% v 4.3%), and prostate cancer mortality (n=1 v n=10). Here we have part 2 of RTOG 0815: the patient-reported quality of life outcomes. These were primarily measured using the EPIC questionnaire, which assess 4 domains: urinary, bowel, sexual, and hormonal. 420 patients from the trial participated in the PRO study. The urinary and bowel scores decreased significantly by the end of treatment. However, there was no difference in these domains between arms, and they both recovered to baseline by 6 months. When it came to the sexual and hormonal domains, though, the ADT arm had a greater decrease than in the RT alone arm. These differences persisted to 6 months, but the differences were nonsignificant at 1 year. By 5 years, sexual and hormonal domains recovered to baseline. Fatigue was also significantly higher in the ADT arm, although the authors deemed the difference not clinically significant. In combination with the treatment outcomes of RTOG 0815, we now have excellent data to counsel patients regarding the benefits and toxicity of short term ADT.
TBL: In men receiving radiation for intermediate risk prostate cancer, the addition of short term ADT reduces the risk of biochemical recurrence and distant metastasis at the cost of 6 months to a year of worse sexual and hormonal quality of life. | Movsas, J Clin Oncol 2023
The Study: Last week, we reviewed the results of RTOG 0815, which showed no improvement in overall survival at 5 years when short term ADT was added to dose escalated radiation for intermediate risk prostate cancer. However, RTOG 0815 clearly showed that, at 8 years, ADT reduced biochemical recurrence (10% v 21%), distant metastasis (1% v 4.3%), and prostate cancer mortality (n=1 v n=10). Here we have part 2 of RTOG 0815: the patient-reported quality of life outcomes. These were primarily measured using the EPIC questionnaire, which assess 4 domains: urinary, bowel, sexual, and hormonal. 420 patients from the trial participated in the PRO study. The urinary and bowel scores decreased significantly by the end of treatment. However, there was no difference in these domains between arms, and they both recovered to baseline by 6 months. When it came to the sexual and hormonal domains, though, the ADT arm had a greater decrease than in the RT alone arm. These differences persisted to 6 months, but the differences were nonsignificant at 1 year. By 5 years, sexual and hormonal domains recovered to baseline. Fatigue was also significantly higher in the ADT arm, although the authors deemed the difference not clinically significant. In combination with the treatment outcomes of RTOG 0815, we now have excellent data to counsel patients regarding the benefits and toxicity of short term ADT.
TBL: In men receiving radiation for intermediate risk prostate cancer, the addition of short term ADT reduces the risk of biochemical recurrence and distant metastasis at the cost of 6 months to a year of worse sexual and hormonal quality of life. | Movsas, J Clin Oncol 2023