Ideal duration of androgen deprivation therapy with post-operative radiotherapy for prostate cancer

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Published: 12 Sep 2022
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Prof Chris Parker - Institute of Cancer Research, Sutton, UK

Prof Chris Parker speaks to ecancer about a study which will ensure clinicians can better tailor treatment for prostate cancer patients following surgery and help facilitate important discussions. This will mean some receive more effective treatment while sparing others unnecessary intervention. 

The trial showed encouraging results for radiotherapy without hormone therapy so some patients, concerned with upsetting side effects of hormone therapy, can be reassured this treatment alone is a good option. Prof Parker explains that for other patients at higher risk of their cancer returning, the results show that two years of hormone therapy is more effective than six months of treatment.

I’ve reported the results of the RADICALS-HD trial which was a trial testing the use of hormone
therapy in combination with post-operative radiotherapy after surgery for prostate cancer. This was a
trial that recruited almost 3,000 men over 15 years in four countries and the results show that the
addition of six months of hormone therapy did not improve metastasis free survival compared with
radiotherapy alone. However, the addition of 24 months of hormone therapy did significantly improve
metastasis free survival compared with six months of hormone treatment.

What impact did this have?

At the moment practice varies according to opinion. So this will provide evidence now that patients
can use to make their choice. Some patients will look at the data and say that the outcomes from
radiotherapy alone is a good outcome and we’ll choose radiotherapy alone; other patients will see the
benefit of 24 months of hormone therapy and will choose that combination. It might be less frequent
now, going forward, for patients to choose six months of hormones together with their post-operative
radiotherapy.

Are you able to speculate on how these results will appear?

This is a matter of speculation but I would say that we’re dealing with microscopic amounts of cancer
in the postoperative setting so radiotherapy alone is sufficient for local control. The added benefit of
hormone therapy is likely eradicating micrometastases and if that’s what hormone therapy is being
asked to do then it explains why 24 months is better than 6 months.