Sweet 18.

Top Line: Deciding on the optimal duration of androgen deprivation therapy (ADT) for prostate cancer can make you feel like you’re at an optometry appointment. Is 36 or 18 months better? Ok now 18 or 6?
The Study: The latest iteration comes from the 10 year results of the TROG RADAR trial. Men with ≥cT2b disease or ≥cT2a + ≥Gleason 7 + ≥PSA 10 receiving definitive radiation were randomized to 6 versus 18 months of ADT +/- zoledronic acid. Importantly, two-thirds of patients were high-risk. The longer duration of ADT reduced the primary outcome of prostate cancer specific mortality from 13% to 10% at 10 years. While overall mortality wasn't statistically lower, it was numerically lower. So longer duration ADT didn't appear to result in more non-cancer deaths. What’s more, distant progression was reduced from 28% to 21% with longer duration ADT, and transition to castration resistance was both reduced and delayed. Zoledronic acid, on the other hand, seemed to have no interaction with prostate cancer.
Bottom Line: Intermediate duration ADT for 18 versus 6 months resulted in superior prostate cancer specific mortality among a group of men with mostly high-risk prostate cancer. | Denham, Lancet Oncol 2018


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