Long-course versus short-course androgen deprivation therapy with postoperative radiotherapy for prostate cancer

The optimal duration of androgen deprivation therapy with postoperative radiotherapy (PORT) after radical prostatectomy for prostate cancer is not clear. In the randomized RADICALS-HD, 6 months of ADT was compared with 24 months of ADT in patients receiving PORT after radical prostatectomy for prostate cancer. The primary endpoint was metastasis-free survival. With a median follow-up of 8.9 years 174 metastasis-free survival events were reported among 761 patients in the 6-months ADT group versus 139 events among 762 patients in the 24-months ADT group (HR 0.733; p=0.029). The 10-year metastasis-free survival was 71.9% (95% CI 67.6-75.7) in the 6-months ADT group versus 78.1% (74.2-81.5) in the 24-months ADT group. Toxicity of grade 3 or higher was reported for 14% of patients in the 6-months ADT group and 19% of patients in the 24-months ADT group (p=0.025), with no treatment-related deaths. The authors conclude that compared with 6 months of ADT, adding 24 months of ADT improved metastasis-free survival in patients receiving PORT after radical prostatectomy for prostate cancer.