Androgen ablation adjuvant to postprostatectomy radiotherapy: complication-adjusted number needed to treat analysis.
OBJECTIVE
To quantify the benefits and harm of androgen ablation (AA) adjuvant to radiotherapy in the postprostatectomy setting. AA is commonly used in the management of prostate cancer.


METHODS
A literature review was performed to estimate the absolute biochemical control advantage for the use of AA concomitant with postprostatectomy external beam radiotherapy. Additionally, a model was developed, with supporting published data, to estimate the utility-adjusted survival detriment due to the side effects of AA, using the number needed to treat (NNT) technique. Using these data, the unadjusted NNTs and the utility-adjusted NNTs for the addition of AA were computed. In all cases, the sign and magnitude of the NNTs obtained were used to gauge the effects of AA.


RESULTS
The unadjusted NNT analysis demonstrated very low values (far less than 20), suggesting a strong benefit for the use of AA, in both adjuvant and salvage radiotherapy settings. Even after adjustment for hormone-induced functional loss, a significant advantage of AA was demonstrated.


CONCLUSIONS
Using the complication-adjusted NNT method, AA appears to be advantageous in both adjuvant and salvage postprostatectomy radiotherapy settings. The results of the present investigation demonstrated the significant role of the NNT technique for uro-oncologic management decisions when treatment complications need to be considered and balanced against the beneficial effects of the treatment.
Jani
Ashesh B
AB
Department of Radiation and Cellular Oncology, University of Chicago Hospitals, Chicago, Illinois 60637, USA.
Sokoloff
Mitchell
M
Shalhav
Arieh
A
Stadler
Walter
W
D000728:Androgens / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant / Q000706:statistics & numerical data; D003657:Decision Making; D006801:Humans; D008297:Male; D011184:Postoperative Period; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*; D018714:Radiotherapy, Adjuvant / Q000706:statistics & numerical data; D018570:Risk Assessment / Q000379:methods*; D016879:Salvage Therapy / Q000706:statistics & numerical data
D000728:Androgens