ADT Combinations With Radiation for Prostate Cancer: A Systematic Review and Meta-analysis

Area of Science:

• Oncology
• Radiotherapy
• Pharmacology

Background:

• Heterogeneous use of LHRHa with or without NSAA in localized prostate cancer radiation.
• Need to clarify the impact of NSAA on survival and toxicity in this context.

Purpose of the Study:

• Determine the effect of NSAA on overall survival (OS), other cause mortality (OCM), and toxicity.
• Evaluate NSAA duration in combination with LHRHa during prostate cancer radiotherapy.

Main Methods:

• Systematic literature search (1966-March 2026) for studies on ADT duration with or without NSAA in localized prostate cancer radiotherapy.
• Exclusion of trials with second-generation NSAA, surgical castration, lifelong, or intermittent ADT.
• PRISMA guidelines followed for data abstraction and quality assessment; random-effects model used for data pooling.

Main Results:

• Prolonging LHRHa duration improved OS, but prolonging NSAA duration did not show a significant OS benefit.
• No significant association found between longer NSAA or LHRHa durations and OCM.
• Prolonging NSAA duration was linked to higher odds of early ADT discontinuation, though confidence intervals were wide.

Conclusions:

• Meta-analysis indicates no OS benefit from prolonging NSAA duration when used with LHRHa.
• Potential association between longer NSAA duration and early ADT discontinuation observed.
• Providers should consider limiting NSAA duration when used with LHRHa to optimize treatment.