<p><strong> </strong><strong>In patients with high-risk prostate cancer electing radiation therapy, clinicians should recommend the addition of long-course (18 to 36 months) ADT with radiation therapy. <em>(Strong Recommendation; Evidence Level: Grade A)</em></strong></p>
Discussion
Discussion
<p>Multiple prospective RCTs have informed the management of high-risk localized prostate cancer to include ADT with radiation based on improved cancer outcomes.<sup>273-286</sup> In particular, the primary evidence for the use of ADT with radiation in high-risk disease comes from EORTC 22863, a trial that randomized 415 patients with locally advanced prostate cancer to 3 years of ADT plus 70 Gy of prostate radiation therapy versus radiation therapy alone.<sup>273-276</sup> Benefits were noted in the combination treatment arm with regard to both prostate cancer-specific survival (HR: 0.38; 95% CI: 0.24 to 0.60) and OS (HR: 0.60; 95% CI: 0.45 to 0.80). From this study, three years of ADT was established as a reference standard ADT treatment for the duration of combined ADT with radiation therapy in the treatment of patients with high-risk prostate cancer. A subsequent RCT among high-risk patients tested 18 versus 36 months of ADT.<sup>294</sup> This trial did not demonstrate differences in disease-free survival (HR: 0.84; 95% CI: 0.68 to 1.02), disease-specific survival (HR: 0.95; 95% CI: 0.58 to 1.55), or OS (HR: 1.02; 95% CI: 0.81 to 1.29) between the treatment durations, and has thereby introduced a minimum threshold duration of ADT when combined with radiation therapy for the management of high-risk disease. The published MARCAP meta-analysis further demonstrates the benefit of ADT in patients treated with radiation therapy.<sup>287</sup></p>