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The trial that proved hormone therapy should be added to radiotherapy for aggressive prostate cancer, and that the addition roughly halves the chance of dying of it.
EORTC 22863 randomised 415 men with prostate cancer at high metastatic risk to radiotherapy alone or to radiotherapy with immediate androgen suppression. Radiotherapy was 50 Gy to the whole pelvis over 5 weeks with a 20 Gy boost to the prostate and seminal vesicles. Goserelin 3.6 mg was given every 4 weeks for 3 years starting on the first day of irradiation, with cyproterone acetate for the first month.
At a median 9.1 years, 10-year clinical disease-free survival was 47.7 percent (95 percent confidence interval 39.0 to 56.0) with combined treatment against 22.7 percent (16.3 to 29.7) with radiotherapy alone, hazard ratio 0.42 (0.33 to 0.55, p<0.0001). Ten-year overall survival was 58.1 percent (49.2 to 66.0) against 39.8 percent (31.9 to 47.5), hazard ratio 0.60 (0.45 to 0.80, p=0.0004), and 10-year prostate cancer mortality 10.3 percent (5.1 to 15.4) against 30.4 percent (23.2 to 37.5), hazard ratio 0.38 (0.24 to 0.60, p<0.0001).
The fear that long hormone therapy would kill men through their hearts was not borne out here: cardiovascular deaths did not differ significantly, whether or not men had cardiovascular problems at entry. Two fractures were reported in the combined arm. That reassurance has limits, because the trial is small and old, and modern evidence for bone and metabolic harm from long androgen deprivation is much stronger.
Numbers are from the trial as recorded here; see the source links in the table below. This is orientation, not medical advice: ask your team how closely the trial population matches you.
415 randomised.
| Endpoint | Arm | n | Value | HR (95% CI) | p | Source |
|---|---|---|---|---|---|---|
| Clinical disease-free survival at 10 yearsprimary | Radiotherapy with 3 years of goserelin | 207 | 47.7% | 0.42 (0.33 to 0.55) | <0.0001 | link |
| Radiotherapy alone | 208 | 22.7% | ||||
| Overall survival at 10 years | Radiotherapy with 3 years of goserelin | 207 | 58.1% | 0.6 (0.45 to 0.8) | 0.0004 | link |
| Radiotherapy alone | 208 | 39.8% | ||||
| Prostate cancer mortality at 10 years | Radiotherapy with 3 years of goserelin | 207 | 10.3% | 0.38 (0.24 to 0.6) | <0.0001 | link |
| Radiotherapy alone | 208 | 30.4% |
Shares EORTC 22991, EORTC 22961, RTOG 92-02, Curative intent vs palliative intent.
Shares EORTC 22991, RTOG 92-02, Curative intent vs palliative intent, Hormone therapy.
Shares EORTC 22961, RTOG 92-02, Hormone therapy, Goserelin / leuprolide (ovarian function suppression).
Shares Curative intent vs palliative intent, Androgen deprivation therapy (ADT), Localised prostate cancer, high and very high risk, Androgen deprivation & AR pathway inhibitors.
Shares Curative intent vs palliative intent, Androgen deprivation therapy (ADT), Localised prostate cancer, high and very high risk, Androgen deprivation & AR pathway inhibitors.
Shares Hormone therapy, Androgen deprivation therapy (ADT), Localised prostate cancer, high and very high risk, Androgen deprivation & AR pathway inhibitors.
Shares SPCG-7/SFUO-3, Hormone Therapy With or Without Surgery or Radiation Therapy in Treating Patients With Prostate Cancer, RTOG 92-02, Androgen deprivation & AR pathway inhibitors.
Shares Hormone therapy, Androgen deprivation therapy (ADT), Localised prostate cancer, high and very high risk, Androgen deprivation & AR pathway inhibitors.