Does short-term ADT before and during radiation therapy improve outcomes in locally advanced prostate cancer?

This Practice Point discusses the 10-year data of the RTOG 8610 trial, published by Roach III and colleagues, which suggest that a short, 4-month course of neoadjuvant-concomitant androgen deprivation therapy (ADT) might be sufficient to improve clinically relevant long-term outcomes in men with bulky, locally advanced prostate cancer. The results show that patients randomized to receive short-term ADT before and during radiation therapy (RT), rather than RT alone, had improved long-term disease-specific mortality, freedom from distant metastases, disease-free survival, freedom from biochemical failure, and possibly even overall survival. Importantly, no increase in the risk of fatal cardiac events was seen. The study did not, however, address the issue of the optimum duration of ADT; recent data suggest that longer courses of ADT (>or=2 years), when added to RT, might further improve disease-free and even overall survival, especially in patients with high-grade disease.