Clinical trials have shown a benefit to adding ADT to radiotherapy for men treated for unfavourable intermediate risk prostate cancer (PCa). However, for men with favorable intermediate risk PCa, adding ADT to radiotherapy doesn’t appear to be much more beneficial than radiotherapy alone.
ADT has many side effects and it is a patient’s choice whether he goes on ADT or not. So, who in the real world elects to take ADT and who avoids it when treated for intermediate risk PCa?
Researchers in the United States conducted a retrospective cohort study to explore trends or variations in ADT use across the country. To do so, they examined data from the National Cancer Database on over 100,000 men diagnosed with PCa, who were undergoing radiotherapy between 2004 -2016. Approximately 60% had favorable (i.e., only one risk factor) and 40% had unfavorable (i.e., more than one risk factor) for intermediate risk disease. Here risk factors were defined according to National Comprehensive Cancer Network criteria. They included: Gleason score 7, PSA 10 – 20 ng/ml, or clinical stage T2b – T2c.
Men < 60 years of age were less likely to receive ADT. The authors postulate that younger men may be less inclined to accept treatment with ADT because of treatment-related side effects; e.g., hot flashes, weight gain, decreased libido. Black men were more likely to receive ADT compared to white men. Additionally, men who lived > 120 miles from the treatment centre were less likely to receive ADT versus those who lived < 60 miles away.
The authors concluded that treatment recommendations are not followed consistently, resulting in some men being “overtreated,” and others being “undertreated.” To make the best decision on treatment for PCa, patients need to understand their disease characteristics—i.e., what constitutes unfavourable versus favourable intermediate risk PCa—and the contexts in which treatment with ADT has survival benefits when added to radiotherapy.
To read the full study, see: https://www.advancesradonc.org/article/S2452-1094(22)00011-2/fulltext
Reference:
Agrawal V, Ma X, Hu JC, Barbieri CE, Nagar H. Trends in Androgen Deprivation Use in Men with Intermediate Risk Prostate Cancer Who Underwent Radiotherapy. Advances in Radiation Oncology. 2022 Feb 4:100904.