Role of combined ADT and salvage radiation therapy after radical prostatectomy in primary pN0-stage

BackgroundSalvage radiation therapy (SRT) is the standard of care for patients with primary pN0 stage and biochemical recurrence after prostatectomy. Recent randomized trials have assessed the potential benefit of adding androgen deprivation therapy (ADT) to SRT.ObjectiveThe results of an evidence-based systematic overview of the use of ADT added to SRT for recurrent prostate cancer are presented.MethodsThe available literature was evaluated and treatment recommendations were derived depending on the patient's risk profile.ResultsThe results of two randomized trials and several retrospective analyses are available. The RTOG 9601 trial showed an overall and prostate cancer-specific survival benefit for the combination of 24months of 150mg bicalutamide daily and SRT compared to SRT alone. This improvement was limited to patients with apre-SRT prostate-specific antigen (PSA) level of 0.7ng/ml, a Gleason score7 or when positive margins were present. The GETUG AFU-16 trial showed that the addition of 6months of goserelin to SRT only improved progression-free survival (PFS) as compared to SRT alone. In both trials ADT was not associated with increased severe delayed sequelae. Results of retrospective series suggest that the addition of ADT improved PFS especially in patients with high-risk factors.ConclusionThe addition of ADT to SRT improves overall survival in patients with apre-SRT PSA 0.7ng/ml. In patients with PSA levels of <0.7ng/ml, ADT should not routinely be used but can be considered in patients with additional risk factors, such as Gleason score 8. In the future, predictive biomarkers could be used to select patients for an additional ADT to SRT. The optimal duration and type of ADT is still unclear. Ongoing clinical trials aim to answer these questions.