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Adding radiotherapy to hormone therapy for locally advanced prostate cancer halves the chance of dying of it, and the side effects are modest.
SPCG-7 asked the mirror image of EORTC 22863: not whether to add hormones to radiotherapy, but whether to add radiotherapy to hormones. It randomised 875 men with locally advanced prostate cancer (T3 in 78 percent, PSA below 70, N0 M0) to endocrine treatment alone (439) or the same endocrine treatment with local radiotherapy (436).
At a median 7.6 years, 79 men in the endocrine-alone group and 37 in the combined group had died of prostate cancer. Cumulative 10-year prostate cancer mortality was 23.9 percent with endocrine treatment alone and 11.9 percent with the combination, a difference of 12.0 percentage points (95 percent confidence interval 4.9 to 19.1) and a relative risk of 0.44 (0.30 to 0.66). Ten-year overall mortality was 39.4 against 29.6 percent, a difference of 9.8 points (0.8 to 18.8), relative risk 0.68 (0.52 to 0.89). Cumulative 10-year PSA recurrence was 74.7 against 25.9 percent (p<0.0001, hazard ratio 0.16, 0.12 to 0.20).
After 5 years, urinary, rectal and sexual problems were slightly more frequent in the combined group. The authors concluded that endocrine treatment plus radiotherapy should be the new standard, and it is.
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.
875 randomised.
Relative risk 0.44 (95 percent confidence interval 0.30 to 0.66).
SourceRelative risk 0.68 (95 percent confidence interval 0.52 to 0.89).
Source| Endpoint | Arm | n | Value | HR (95% CI) | p | Source |
|---|---|---|---|---|---|---|
| Prostate cancer mortality at 10 yearsprimary | Endocrine treatment with radiotherapy | 436 | 11.9% | - | - | link |
| Endocrine treatment alone | 439 | 23.9% | ||||
| Overall mortality at 10 years | Endocrine treatment with radiotherapy | 436 | 29.6% | - | - | link |
| Endocrine treatment alone | 439 | 39.4% |
Shares EORTC 22863, Curative intent vs palliative intent, Hormone therapy, Androgen deprivation therapy (ADT).
Shares EORTC 22863, Flutamide, Hormone therapy, Androgen deprivation therapy (ADT).
Shares EORTC 22863, Curative intent vs palliative intent, Androgen deprivation therapy (ADT), Localised prostate cancer, high and very high risk.
Shares Flutamide, Curative intent vs palliative intent, Hormone therapy, Androgen deprivation therapy (ADT).
Shares Curative intent vs palliative intent, Hormone therapy, Androgen deprivation therapy (ADT), 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 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 With or Without Surgery or Radiation Therapy in Treating Patients With Prostate Cancer, Flutamide, Androgen deprivation & AR pathway inhibitors, Prostate cancer.