title: Androgen ablation adjuvant to postprostatectomy radiotherapy: complication-adjusted number needed to treat analysis.
abstract: 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.
authors.affiliation: Department of Radiation and Cellular Oncology, University of Chicago Hospitals, Chicago, Illinois 60637, USA.
authors.forename: Ashesh B
authors.initials: AB
authors.lastname: Jani
authors.forename: Mitchell
authors.initials: M
authors.lastname: Sokoloff
authors.forename: Arieh
authors.initials: A
authors.lastname: Shalhav
authors.forename: Walter
authors.initials: W
authors.lastname: Stadler
mesh_terms: 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
chemical_list: D000728:Androgens