• Padraig Warde, Malcolm Mason, Keyue Ding, Peter Kirkbride, Michael Brundage, Richard Cowan, Mary Gospodarowicz, Karen Sanders, Edmund Kostashuk, Greg Swanson, Jim Barber, Andrea Hiltz, Mahesh K B Parmar, Jinka Sathya, John Anderson, Charles Hayter, John Hetherington, Matthew R Sydes, Wendy Parulekar, and NCIC CTG PR.3/MRC UK PR07 investigators.
• Princess Margaret Hospital, Toronto, Canada. padraig.warde@rmp.uhn.on.ca
• Lancet. 2011 Dec 17;378(9809):2104-11.

BackgroundWhether the addition of radiation therapy (RT) improves overall survival in men with locally advanced prostate cancer managed with androgen deprivation therapy (ADT) is unclear. Our aim was to compare outcomes in such patients with locally advanced prostate cancer.MethodsPatients with: locally advanced (T3 or T4) prostate cancer (n=1057); or organ-confined disease (T2) with either a prostate-specific antigen (PSA) concentration more than 40 ng/mL (n=119) or PSA concentration more than 20 ng/mL and a Gleason score of 8 or higher (n=25), were randomly assigned (done centrally with stratification and dynamic minimisation, not masked) to receive lifelong ADT and RT (65-69 Gy to the prostate and seminal vesicles, 45 Gy to the pelvic nodes). The primary endpoint was overall survival. The results presented here are of an interim analysis planned for when two-thirds of the events for the final analysis were recorded. All efficacy analyses were done by intention to treat and were based on data from all patients. This trial is registered at controlledtrials.com as ISRCTN24991896 and Clinicaltrials.gov as NCT00002633.ResultsBetween 1995 and 2005, 1205 patients were randomly assigned (602 in the ADT only group and 603 in the ADT and RT group); median follow-up was 6·0 years (IQR 4·4-8·0). At the time of analysis, a total of 320 patients had died, 175 in the ADT only group and 145 in the ADT and RT group. The addition of RT to ADT improved overall survival at 7 years (74%, 95% CI 70-78 vs 66%, 60-70; hazard ratio [HR] 0·77, 95% CI 0·61-0·98, p=0·033). Both toxicity and health-related quality-of-life results showed a small effect of RT on late gastrointestinal toxicity (rectal bleeding grade >3, three patients (0·5%) in the ADT only group, two (0·3%) in the ADT and RT group; diarrhoea grade >3, four patients (0·7%) vs eight (1·3%); urinary toxicity grade >3, 14 patients (2·3%) in both groups).InterpretationThe benefits of combined modality treatment--ADT and RT--should be discussed with all patients with locally advanced prostate cancer.FundingCanadian Cancer Society Research Institute, US National Cancer Institute, and UK Medical Research Council.Copyright © 2011 Elsevier Ltd. All rights reserved.

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