Influence of Timing Between Androgen Deprivation Therapy and External Beam Radiation Therapy in Patients With Localized, High-Risk Prostate Cancer

McCall, Neal S.; Liu, Yuan; Patel, Sagar; Hershatter, Bruce; Moghanaki, Drew; Godette, Karen D.; Hanasoge, Sheela; Patel, Pretesh; Fischer‐Valuck, Benjamin W.; Shelton, Joseph; Jani, Ashesh B.

doi:10.1016/j.adro.2021.100803

Cited by 3 publications

(3 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A recent large individual patient data meta-analysis by Kishan et al, mainly including HR and IR PCa, reported no benefit in MFS when prolonging NAHT from 3–4 months to 6–9 months [ 56 ]. On the other hand, an NCDB study including 37,606 patients with HR PCa treated with RT plus ADT found improved OS when NAHT was given for 8–11 weeks compared to shorter courses (HR 0.9), but not when extending it beyond 11 weeks [ 57 ]. These results suggest that if an underlying benefit to neoadjuvant ADT exists, it could be marred by a delay of over 3 months of the definitive ablative treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, the exclusion of patients receiving pelvic RT and long-term ADT in Spratt’s meta-analysis precludes extrapolating their results to HR PCa. This may warrant further study given the intriguing results seen in the NCDB studies using the NAHT approach [ 50 , 57 ]. Moreover, the recently presented SANDSTORM study showed that in patients receiving WPRT, C-AHT was associated with higher rates of distant metastases and the authors support that NA-CHT should be preferred when pelvic RT is indicated [ 59 ].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Neoadjuvant versus Concurrent Androgen Deprivation Therapy in Localized Prostate Cancer Treated with Radiotherapy: A Systematic Review of the Literature

Cartes

Karim

Tisseverasinghe

et al. 2023

Cancers

View full text Add to dashboard Cite

Background: There is an ongoing debate on the optimal sequencing of androgen deprivation therapy (ADT) and radiotherapy (RT) in patients with localized prostate cancer (PCa). Recent data favors concurrent ADT and RT over the neoadjuvant approach. Methods: We conducted a systematic review in PubMed, EMBASE, and Cochrane Databases assessing the combination and optimal sequencing of ADT and RT for Intermediate-Risk (IR) and High-Risk (HR) PCa. Findings: Twenty randomized control trials, one abstract, one individual patient data meta-analysis, and two retrospective studies were selected. HR PCa patients had improved survival outcomes with RT and ADT, particularly when a long-course Neoadjuvant-Concurrent-Adjuvant ADT was used. This benefit was seen in IR PCa when adding short-course ADT, although less consistently. The best available evidence indicates that concurrent over neoadjuvant sequencing is associated with better metastases-free survival at 15 years. Although most patients had IR PCa, HR participants may have been undertreated with short-course ADT and the absence of pelvic RT. Conversely, retrospective data suggests a survival benefit when using the neoadjuvant approach in HR PCa patients. Interpretation: The available literature supports concurrent ADT and RT initiation for IR PCa. Neoadjuvant-concurrent-adjuvant sequencing should remain the standard approach for HR PCa and is an option for IR PCa.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Neoadjuvant versus Concurrent Androgen Deprivation Therapy in Localized Prostate Cancer Treated with Radiotherapy: A Systematic Review of the Literature

Cartes

Karim

Tisseverasinghe

et al. 2023

Cancers

View full text Add to dashboard Cite

show abstract

“…This suggests that 6-month NADT combined with RT is an effective treatment for patients with locally advanced PCa, particularly in men without pre-existing metabolic or nodal metastatic comorbidities that could be exacerbated by extended ADT [62]. Another study also showed that NADT initiation 8 to 11 weeks before RT is associated with significantly improved OS compared with shorter NADT duration in high or very high-risk PCa patients [63]. Contrarily, a recent meta-analysis reported that NADT extension from 3-4 months to 6-9 months in patients with localized PCa receiving RT does not improve MFS, indicating that the magnitude of the benefit could vary [64].…”

Section: Rt + Nadt Vs Rt Alonementioning

confidence: 98%

Review of Current Treatment Intensification Strategies for Prostate Cancer Patients

Wasim,

Park,

Nam

et al. 2023

Cancers

View full text Add to dashboard Cite

Prostate cancer (PCa) used to be one of the most common nondermatologic cancers in men that can be treated only with surgery. However, a revolutionary breakthrough came in the 1980s with the introduction of long-acting luteinizing hormone-releasing hormone (LHRH) agonists for the curative treatment of PCa. This paradigm shift contributed to the combined use of androgen deprivation therapy (ADT), chemotherapy, and radiotherapy for the treatment. The latest data highlight the use of treatment intensification (TI), i.e., combined use of radiotherapy (RT) and hormonal or drug treatments, for localized or locally advanced PCa. Indeed, the results of combined modality treatments have shown a reduction in disease-specific mortality and improved overall survival. Although TI seems promising, more research studies are warranted to confirm its efficacy. This review summarizes the latest available outcome results of pivotal trials and clinical studies on the efficacy of TI.

show abstract

Estimation of Prostate Cancer Cost in Egypt From a Societal Perspective

Elsisi,

El-Attar,

Ismaeil

et al. 2023

Global Journal on Quality and Safety in Healthcare

View full text Add to dashboard Cite

Introduction The main objective of this study was to assess the cost of prostate cancer over a 1-year period from a societal perspective. Methods We constructed a cost-of-illness model to assess the cost of different health states of prostate cancer, metastatic or nonmetastatic, among Egyptian men. Population data and clinical parameters were extracted from the published literature. We relied on different clinical trials to extract clinical data. We considered all direct medical costs, including the costs of treatment and required monitoring, in addition to the indirect costs. The unit costs were captured from Nasr City Cancer Center and Egyptian Authority for Unified Procurement, Medical Supply, and Management of Medical Technology, and resource utilization were collected from clinical trials and validated by the Expert Panel. One-way sensitivity analysis was conducted to ensure model robustness. Results The number of targeted patients with nonmetastatic hormone-sensitive prostate cancer, hormone-sensitive prostate cancer, and metastatic castration-resistant prostate cancer was 215,207, 263,032, and 116,732, respectively. The total costs, in Egyptian pounds (EGP) and US dollars (USD), for the targeted patients, including drug costs and nondrug costs over a time horizon of 1 year, were EGP 41.44 billion (USD 9.010 billion) for localized prostate cancer; for metastatic prostate cancer, they doubled to EGP 85.14 billion (USD 18.510 billion), which reflects a huge burden on the Egyptian healthcare system. The drug costs for localized and metastatic prostate cancer are EGP 41,155,038,137 (USD 8.946 billion) and EGP 81,384,796,471 (USD 17.692 billion), respectively. A significant difference in nondrug costs between localized and metastatic prostate cancer was demonstrated. Nondrug costs were estimated at EGP 293,187,203 (USD 0.063 billion) for localized prostate cancer and EGP 3,762,286,092 (USD 0.817 billion) for metastatic prostate cancer. This significant difference in nondrug costs highlights the importance of early treatment due to the increased costs of progression and the burden of follow-up and productivity loss associated with metastatic prostate cancer. Conclusion Metastatic prostate cancer has a huge economic burden on the Egyptian healthcare system compared with localized prostate cancer owing to the increased costs of progression, follow-up, and productivity loss. This highlights the necessity of early treatment of these patients to save costs and lighten the burden of the disease on the patient, society, and economy.

show abstract

Influence of Timing Between Androgen Deprivation Therapy and External Beam Radiation Therapy in Patients With Localized, High-Risk Prostate Cancer

Cited by 3 publications

References 22 publications

Neoadjuvant versus Concurrent Androgen Deprivation Therapy in Localized Prostate Cancer Treated with Radiotherapy: A Systematic Review of the Literature

Neoadjuvant versus Concurrent Androgen Deprivation Therapy in Localized Prostate Cancer Treated with Radiotherapy: A Systematic Review of the Literature

Review of Current Treatment Intensification Strategies for Prostate Cancer Patients

Estimation of Prostate Cancer Cost in Egypt From a Societal Perspective

Contact Info

Product

Resources

About