Context Survival benefit in the management of high-grade clinically localized
prostate cancer has been shown for 70 Gy radiation therapy combined with 3
years of androgen suppression therapy (AST), but long-term AST is associated
with many adverse events.
Objective To assess the survival benefit of 3-dimensional conformal radiation
therapy (3D-CRT) alone or in combination with 6 months of AST in patients
with clinically localized prostate cancer.
Design, Setting, and Patients A prospective randomized controlled trial of 206 patients with clinically
localized prostate cancer who were randomized to receive 70 Gy 3D-CRT alone
(n = 104) or in combination with 6 months of AST (n = 102) from December 1,
1995, to April 15, 2001. Eligible patients included those with a prostate-specific
antigen (PSA) of at least 10 ng/mL, a Gleason score of at least 7, or radiographic
evidence of extraprostatic disease.
Main Outcome Measures Time to PSA failure (PSA >1.0 ng/mL and increasing >0.2 ng/mL on 2 consecutive
visits) and overall survival.
Results After a median follow-up of 4.52 years, patients randomized to receive
3D-CRT plus AST had a significantly higher survival (P =
.04), lower prostate cancer–specific mortality (P = .02), and higher survival free of salvage AST (P = .002). Kaplan-Meier estimates of 5-year survival rates were 88%
(95% confidence interval [CI], 80%-95%) in the 3D-CRT plus AST group vs 78%
(95% CI, 68%-88%) in the 3D-CRT group. Rates of survival free of salvage AST
at 5 years were 82% (95% CI, 73%-90%) in the 3D-CRT plus AST group vs 57%
(95% CI, 46%-69%) in the 3D-CRT group.
Conclusion The addition of 6 months of AST to 70 Gy 3D-CRT confers an overall survival
benefit for patients with clinically localized prostate cancer.