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