Megatron28
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Thought I would share study I came across.
Re: Long-Term Follow-up of a Randomized Trial of Radiation with or without Androgen Deprivation Therapy for Localized Prostate Cancer
Samir S. Taneja, MD
Published Online: February 10, 2016
Article has an altmetric score of 5
DOI: http://dx.doi.org/10.1016/j.juro.2016.02.022
Article Info click to expand contents
A. V. D***8217;Amico, M. H. Chen, A. Renshaw, M. Loffredo and P. W. Kantoff
Department of Radiation Oncology, Brigham and Women***8217;s Hospital, and Department of Medicine, Dana Farber Cancer Institute, Boston, Massachusetts, Department of Statistics, University of Connecticut, Storrs, Connecticut, and Department of Pathology, Miami Baptist Hospital, Miami, Florida
JAMA 2015; 314: 1291***8211;1293. doi: 10.1001/jama.2015.8577
No Abstract
Editorial Comment
Since randomized data have supported use of androgen deprivation therapy (ADT) at external beam radiation for men with high risk prostate cancer, the use of ADT has become the standard of care for most. There has been considerable controversy regarding duration of use, risk profiles in which benefit could be achieved and timing relative to radiation therapy. Recently demonstration of substantive long-term cardiovascular, ********* and cognitive toxicity has resulted in more caution in recommending ADT, particularly in elderly patients with preexisting cardiovascular disease.
In this study the authors evaluate long-term outcomes among men receiving external beam radiation therapy with or without 6 months of ADT for unfavorable risk prostate cancer. Early analysis of the data indicated that the addition of ADT resulted in improved mortality. However, at the current followup of 16.62 years no reduction in mortality was seen overall for men receiving radiation alone. When segregating men by level of comorbid conditions, improved overall and cancer specific survival was seen with the addition of ADT in men with little to no comorbidity. The opposite effect was seen in men with moderate to high comorbidity. In these men the addition of ADT reduced overall survival, increased cardiac event related mortality and had no effect on cancer specific mortality.
The implications of the findings are broad and suggest, as in many other examples, that individualized application of beneficial therapies likely supersedes level I evidence derived at the population level. One could argue that the duration of ADT may influence effects on cancer specific mortality in the whole group, although the effect of ADT on cardiac mortality in the ADT treated moderate to severe comorbidity group is hard to deflate. In this group 23 of 24 men died, of whom 16 died of cardiac causes and 1 of prostate cancer. In the whole group of men with moderate to severe comorbidity 46 of 49 died, of which only 4 deaths were prostate attributed. The take home message? Prostate cancer treatment among those with high risk prostate cancer should be approached with caution, and judicious use of ADT in this setting, despite the evidence-based benefit, is warranted.
http://www.jurology.com/issue/S0022...cle/S0022-5347(16)00264-0/fulltext?mobileUi=1
Re: Long-Term Follow-up of a Randomized Trial of Radiation with or without Androgen Deprivation Therapy for Localized Prostate Cancer
Samir S. Taneja, MD
Published Online: February 10, 2016
Article has an altmetric score of 5
DOI: http://dx.doi.org/10.1016/j.juro.2016.02.022
Article Info click to expand contents
A. V. D***8217;Amico, M. H. Chen, A. Renshaw, M. Loffredo and P. W. Kantoff
Department of Radiation Oncology, Brigham and Women***8217;s Hospital, and Department of Medicine, Dana Farber Cancer Institute, Boston, Massachusetts, Department of Statistics, University of Connecticut, Storrs, Connecticut, and Department of Pathology, Miami Baptist Hospital, Miami, Florida
JAMA 2015; 314: 1291***8211;1293. doi: 10.1001/jama.2015.8577
No Abstract
Editorial Comment
Since randomized data have supported use of androgen deprivation therapy (ADT) at external beam radiation for men with high risk prostate cancer, the use of ADT has become the standard of care for most. There has been considerable controversy regarding duration of use, risk profiles in which benefit could be achieved and timing relative to radiation therapy. Recently demonstration of substantive long-term cardiovascular, ********* and cognitive toxicity has resulted in more caution in recommending ADT, particularly in elderly patients with preexisting cardiovascular disease.
In this study the authors evaluate long-term outcomes among men receiving external beam radiation therapy with or without 6 months of ADT for unfavorable risk prostate cancer. Early analysis of the data indicated that the addition of ADT resulted in improved mortality. However, at the current followup of 16.62 years no reduction in mortality was seen overall for men receiving radiation alone. When segregating men by level of comorbid conditions, improved overall and cancer specific survival was seen with the addition of ADT in men with little to no comorbidity. The opposite effect was seen in men with moderate to high comorbidity. In these men the addition of ADT reduced overall survival, increased cardiac event related mortality and had no effect on cancer specific mortality.
The implications of the findings are broad and suggest, as in many other examples, that individualized application of beneficial therapies likely supersedes level I evidence derived at the population level. One could argue that the duration of ADT may influence effects on cancer specific mortality in the whole group, although the effect of ADT on cardiac mortality in the ADT treated moderate to severe comorbidity group is hard to deflate. In this group 23 of 24 men died, of whom 16 died of cardiac causes and 1 of prostate cancer. In the whole group of men with moderate to severe comorbidity 46 of 49 died, of which only 4 deaths were prostate attributed. The take home message? Prostate cancer treatment among those with high risk prostate cancer should be approached with caution, and judicious use of ADT in this setting, despite the evidence-based benefit, is warranted.
http://www.jurology.com/issue/S0022...cle/S0022-5347(16)00264-0/fulltext?mobileUi=1
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