Salvage Radiotherapy Plus Androgen Deprivation After Surgery for Prostate Cancer
Posted: Thursday, March 5, 2020
According to a 112-month follow-up of a phase III study published in The Lancet Oncology, a combination treatment of salvage radiotherapy and androgen suppression appear to result in significant survival benefits for patients with prostate cancer who have already undergone radical prostatectomy. “The results of the GETUG-AFU 16 trial confirm the efficacy of androgen suppression plus radiotherapy as salvage treatment in patients with increasing [prostate-specific antigen] concentration after radical prostatectomy for prostate cancer,” concluded Christian Carrie, MD, of the Léon Bérard Center, France, and colleagues.
The multicenter trial included 743 men with prostate cancer who were randomly assigned to receive either radiotherapy alone (three-dimensional conformal radiotherapy or intensity-modulated radiotherapy) of 66 Gy in 33 fractions for 5 days a week for 7 weeks (n = 374) or radiotherapy plus 10.8 mg of the subcutaneous short-term androgen suppressor goserelin on the first day of irradiation and again 3 months later (n = 369). Patients undergoing combination therapy experienced a superior 120-month progression-free survival of 64% (95% confidence interval [CI] = 58%–69%) compared with 49% for patients experiencing radiotherapy alone (95% CI = 43%–54%). Two cases of secondary cancer unrelated to treatment occurred. No treatment-related deaths were reported.
Participants included men whose prostate-specific antigen concentration had increased from 0.1 ng/mL to between 0.2 and 2.0 ng/mL after radical prostatectomy and who had not undergone previous androgen-suppression treatment or pelvic radiotherapy. In addition, patients had either stage pT2, T3, or T4a disease with no pN0 or pNx as determined by the tumor, node, metastasis staging system.
Of note, metastasis-free survival was prespecified as an endpoint of this trial. “This outcome has recently been approved by the U.S. Food and Drug Administration as an endpoint for men with prostate cancer enrolled in clinical trials and has been described as a strong surrogate of overall survival,” the authors commented.
Disclosure: For full disclosures of the study authors, please visit thelancet.com.