A wealth of studies have shown that adding ADT to radiotherapy, when used to treat localized prostate cancer, can improve outcomes. But a question remains: “When should one start on the ADT in relation to the radiotherapy?”
If one starts the ADT before the radiotherapy, that is formally called neoadjuvant ADT. If one starts ADT at the same time as the radiotherapy, that is called adjuvant ADT. In Canada, where we are based, it is typical to start the ADT early, in the neoadjuvant mode. But that may soon change based on an excellent review of this topic just published in the prestigious Journal of Clinical Oncology.
The main conclusion from the review is that men treated with ADT, when starting prostate-directed radiotherapy, have “improved biochemical control and metastatic free survival“ compared to those patients who started the ADT early (i.e., as neoadjuvant therapy). In simple English, the authors of the study saw no advantage in delaying the start of radiotherapy with a preliminary course of ADT.
Oncologists, who follow the conclusions of this review, are likely in the future to be prescribing ADT for a shorter length time in patients who are getting radiotherapy as a primary treatment for localized prostate cancer.
To read the study abstract, see: https://pubmed.ncbi.nlm.nih.gov/33275486/
Spratt DE, Malone S, Roy S, Grimes S, Eapen L, Morgan SC, Malone J, Craig J, Dess RT, Jackson WC, Hartman HE, Kishan AU, Mehra R, Kaffenberger S, Morgan TM, Reichert ZR, Alumkal JJ, Michalski J, Lee WR, Pisansky TM, Feng FY, Shipley W, Sandler HM, Schipper MJ, Roach M, Sun Y, Lawton CAF. Prostate Radiotherapy With Adjuvant Androgen Deprivation Therapy (ADT) Improves Metastasis-Free Survival Compared to Neoadjuvant ADT: An Individual Patient Meta-Analysis. J Clin Oncol. 2020 Dec 4:JCO2002438. doi: 10.1200/JCO.20.02438. Epub ahead of print.