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Two extra years of hormone therapy after radiotherapy improved every measure of cancer control, but only men with the most aggressive tumours lived longer for it.
RTOG 92-02 entered 1,554 men with T2c to T4 prostate cancer, no extrapelvic nodes and a PSA below 150. All received 4 months of goserelin and flutamide before and during radiotherapy of 45 Gy to the pelvic nodes and 65 to 70 Gy to the prostate, and were then randomised to no further androgen deprivation or to 24 further months of goserelin. Median follow-up of survivors was 11.3 years.
At 10 years the long-course arm was better on every endpoint except overall survival: disease-free survival 22.5 against 13.2 percent (p<0.0001), disease-specific survival 88.7 against 83.9 percent (p=0.0042), local progression 12.3 against 22.2 percent (p<0.0001), distant metastasis 14.8 against 22.8 percent (p<0.0001) and biochemical failure 51.9 against 68.1 percent (p at most 0.0001). Overall survival was 53.9 against 51.6 percent, p=0.36.
The exception was the prespecified subgroup with Gleason 8 to 10 tumours, where overall survival was 45.1 percent with long-course against 31.9 percent with short-course treatment (p=0.0061). That subgroup is why long-course androgen deprivation became the standard for the highest-grade localised disease, and why men with Gleason 7 disease are more often offered a shorter course.
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.
1,554 randomised.
| Endpoint | Arm | n | Value | HR (95% CI) | p | Source |
|---|---|---|---|---|---|---|
| Overall survival at 10 years, all patientsprimary | Long-course androgen deprivation, 28 months total | - | 53.9% | - | 0.36 | link |
| Short-course androgen deprivation, 4 months | - | 51.6% | ||||
| Overall survival at 10 years, Gleason 8 to 10 | Long-course androgen deprivation, 28 months total | - | 45.1% | - | 0.0061 | link |
| Short-course androgen deprivation, 4 months | - | 31.9% | ||||
| Distant metastasis at 10 years | Long-course androgen deprivation, 28 months total | - | 14.8% | - | <0.0001 | link |
| Short-course androgen deprivation, 4 months | - | 22.8% |
Shares EORTC 22863, Flutamide, Hormone therapy, Androgen deprivation therapy (ADT).
Shares RTOG 94-08, EORTC 22863, DART 01/05 GICOR, Androgen deprivation therapy (ADT).
Shares Gleason score / Grade Group, Androgen deprivation therapy (ADT), NRG Oncology, Localised prostate cancer, high and very high risk.
Shares What androgen deprivation costs: the side of hormone therapy the survival curves do not show, Hormone therapy, Androgen deprivation therapy (ADT), Localised prostate cancer, high and very high risk.
Shares EORTC 22863, Flutamide, Goserelin / leuprolide (ovarian function suppression), Localised prostate cancer, high and very high risk.
Shares What androgen deprivation costs: the side of hormone therapy the survival curves do not show, Hormone therapy, Androgen deprivation therapy (ADT), Localised prostate cancer, high and very high risk.
Shares What androgen deprivation costs: the side of hormone therapy the survival curves do not show, Hormone therapy, Androgen deprivation therapy (ADT), Androgen deprivation & AR pathway inhibitors.
Shares Flutamide, Goserelin / leuprolide (ovarian function suppression), NRG Oncology, Prostate cancer.