Androgen Deprivation Therapy Use in the Setting of High-Dose Radiation Therapy and the Risk of Prostate Cancer-Specific Mortality Stratified by the Extent of Competing Mortality

Publication date: Available online 22 August 2016
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Brent S. Rose, Ming-Hui Chen, Jing Wu, Michelle H. Braccioforte, Brian J. Moran, Daniel E. Doseretz, Michael J. Katin, Rudolf H. Ross, Sharon A. Salenius, Anthony V. D'Amico
PurposeThe addition of androgen deprivation therapy (ADT) to radiation therapy (RT) is standard of care for men with intermediate and high-risk prostate cancer (PC). However, whether competing mortality impacts the ability of ADT to improve survival remains unanswered.Methods and MaterialsWe calculated a competing mortality (CM) risk score using a Fine-Gray semi-parametric model including age and cardiometabolic comorbidities from a cohort of 17,669 men treated with high-dose RT with or without supplemental ADT for non-metastatic PC. Fine and Gray competing risk regression was used to assess whether ADT reduced the risk of prostate cancer-specific mortality (PCSM) for men with low vs. high risk of CM amongst the 4,550 patients within the intermediate and high-risk cohort adjusted for established PC prognostic factors, year of treatment, site, and ADT treatment propensity score.ResultsAfter a median follow-up of 8.4 years 1,065 men died; 89 (8.36%) from PC. Among men with a low CM score, ADT use was associated with a significant reduction in the risk of PCSM (adjusted HR (AHR): 0.35, 95% CI: 0.14 to 0.87, p = 0.02) but not in men with a high CM score (AHR: 1.33, 95% CI: 0.77 to 2.30, p = 0.30).ConclusionsAdding ADT to high-dose RT appears to be associated with decreased PCSM-risk in men with low but not high CM. These data should serve to heighten awareness about the importance of considering competing risks when determining whether or not to add ADT to RT to treat older men with intermediate or high-risk PC.

Teaser

Adding androgen deprivation therapy (ADT) to high-dose radiation therapy (RT) appears to be associated with decreased prostate cancer-specific mortality (PCSM) risk in men with low but not high competing mortality (CM). These data should serve to heighten awareness about the importance of considering competing risks when determining whether or not to add ADT to RT to treat older men with intermediate or high-risk PC. 


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