WASHINGTON, DC USA (UroToday.com) - Immediate compared with deferred androgen deprivation therapy results in a modest increase in overall survival but no significant difference in prostate cancer mortality according to this update from the EORTC Trial 30891.
The study compared immediate androgen deprivation treatment (ADT) to deferred treatment initiated at the time of symptomatic disease progression or life-threatening complications with T0-4 N0-2 M0 prostate cancer. They now have 12.9 years of median follow-up in 985 randomized patients.
This original study aim was to test for equivalent overall survival using deferred ADT compared to immediate ADT. Prostate cancer mortality was a secondary endpoint. The first results published by Professor Studer et al. in 2006 showed a modest but significant increase in overall survival and no difference in prostate cancer mortality. In this update 769 patients have now died (78.1%), with prostate cancer being a cause of death in 269 (27.3%). The overall survival hazard ratio is 1.21 favoring immediate treatment. The updated results confirm that overall survival is not equivalent, seemingly due to fewer deaths of non-prostate cancer causes. The mortality due to prostate cancer did not differ and at 10 years the cumulative incidence of prostate cancer deaths was 22.2% with deferred and 21.0% with immediate ADT. At 10 years, only 52.8% of the patients on deferred treatment had required initiation of ADT. Overall, 152 of 493 patients (30.8%) randomized to deferred ADT died of other causes without ever needing treatment for prostate cancer. The difference in survival is mainly caused by a greater number of deaths in the deferred treatment arm in years 3 to 5 following randomization. The small increase in overall survival must be weighed against the side effects of ADT, they concluded.
Presented by Urs Studer, et al. at the American Urological Association (AUA) Annual Meeting - May 14 - 19, 2011 - Walter E. Washington Convention Center, Washington, DC USA
Reported for UroToday by Christopher P. Evans, MD, FACS, Professor and Chairman, Department of Urology, University of California, Davis, School of Medicine.
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