title: Survival benefit associated with adjuvant androgen deprivation therapy combined with radiotherapy for high- and low-risk patients with nonmetastatic prostate cancer.
abstract: BACKGROUND
  The use of adjuvant androgen deprivation therapy (ADT) combined with radiotherapy has become common in low-risk patients, although clinical trials have focused primarily on high-risk patients. This study examines the effectiveness of adjuvant ADT combined with radiotherapy for a wide range of patients treated in the 1990s.
  
  
  METHODS
  Prostate cancer survival was examined in a population based cohort of 31,643 patients aged 65 to 85 years who were diagnosed with nonmetastatic prostate cancer and treated with external beam radiotherapy and/or brachytherapy. Instrumental variable analysis methods were used to control for selection bias.
  
  
  RESULTS
  Patients with stage T3/T4 disease who received adjuvant ADT experienced improved 5-year and 8-year survival. No survival advantage was observed for men with T1/T2 disease during this interval.
  
  
  CONCLUSIONS
  High-risk patients who receive primary radiotherapy have benefited from adjuvant ADT, whereas low-risk patients with disease confined to the prostate have not yet benefited from adjuvant therapy within the first 8 years after treatment. These findings are consistent with practice guidelines, which recommend adjuvant ADT for patients with high-risk disease.
authors.affiliation: Fred Hutchinson Cancer Research Center, Health Services Department, University of Washington School of Public Health and Community Medicine, Seattle, WA 98109-1024, USA. szeliadt@fhcrc.org
authors.forename: Steven B
authors.initials: SB
authors.lastname: Zeliadt
authors.forename: Arnold L
authors.initials: AL
authors.lastname: Potosky
authors.forename: David F
authors.initials: DF
authors.lastname: Penson
authors.forename: Ruth
authors.initials: R
authors.lastname: Etzioni
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000726:Androgen Antagonists / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D018426:SEER Program; D012959:Socioeconomic Factors; D016019:Survival Analysis
chemical_list: D000726:Androgen Antagonists