title: Short-course androgen deprivation therapy and the risk of death from high-risk prostate cancer in men undergoing external beam radiation therapy and brachytherapy.
abstract: OBJECTIVE
  We estimated the risks of prostate cancer-specific mortality (PCSM) and all-cause mortality (ACM) in men with high-risk prostate cancer (PC) undergoing external beam radiation therapy and brachytherapy with short-course androgen deprivation therapy (ADT) (median 4 months) as compared with men with more favorable-risk PC undergoing standard of care as per the National Comprehensive Cancer Network guidelines.
  
  
  METHODS
  The prospective study cohort comprised 6595 consecutively treated men with T1-4 N0M0 PC whose treatment included brachytherapy between October 16, 1997, and May 28, 2013. Fine and Gray competing risk regression and Cox regression analyses were used to assess the risks of PCSM and ACM in men with high, unfavorable intermediate, and favorable intermediate risk as compared with low-risk PC.
  
  
  RESULTS
  After median followup of 7.76 years, 820 men died (12.43%): 72 of PC (8.78%). Men with favorable intermediate-risk PC did not have significantly increased PCSM risk as compared with men with low-risk PC (adjusted hazard ratio [AHR], 1.26; 95% confidence interval [CI] 0.56, 2.88; p-Value 0.58), whereas men with high-risk PC (AHR, 3.74; 95% CI 1.12, 12.53; p-Value 0.032) and unfavorable intermediate-risk PC (AHR, 3.10; 95% CI 1.43, 6.72; p-Value 0.004) did. Based on 10-year adjusted point estimates of PCSM and ACM for men with high-risk PC being 6.01% (95% CI 3.79%, 8.94%) and 21.30% (95% CI 17.45%, 25.42%), respectively, PCSM comprised 28% of ACM.
  
  
  CONCLUSIONS
  In the setting of external beam radiation therapy and brachytherapy, men with high-risk PC have low absolute adjusted estimates of PCSM (~6%) during the first decade after treatment despite receiving only short-course ADT. Whether long-term ADT can lower PCSM and improve survival in these men requires additional study.
authors.affiliation: Harvard Radiation Oncology Program, Boston, MA; Department of Radiation Oncology, Brigham and Women's Hospital-Dana-Farber Cancer Institute, Boston, MA. Electronic address: araldow@partners.org.
authors.forename: Ann C
authors.initials: AC
authors.lastname: Raldow
authors.affiliation: Department of Statistics, University of Connecticut, Storrs, CT.
authors.forename: Danjie
authors.initials: D
authors.lastname: Zhang
authors.affiliation: Department of Statistics, University of Connecticut, Storrs, CT.
authors.forename: Ming-Hui
authors.initials: MH
authors.lastname: Chen
authors.affiliation: Prostate Cancer Foundation of Chicago, Westmont, IL.
authors.forename: Michelle H
authors.initials: MH
authors.lastname: Braccioforte
authors.affiliation: Prostate Cancer Foundation of Chicago, Westmont, IL.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Moran
authors.affiliation: Department of Radiation Oncology, Brigham and Women's Hospital-Dana-Farber Cancer Institute, Boston, MA.
authors.forename: Anthony V
authors.initials: AV
authors.lastname: D'Amico
mesh_terms: D000368:Aged; D000726:Androgen Antagonists / Q000008:administration & dosage*; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D001918:Brachytherapy; D002423:Cause of Death; D059248:Chemoradiotherapy; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000401:mortality* / Q000628:therapy*; D012307:Risk Factors
chemical_list: D000726:Androgen Antagonists; D000970:Antineoplastic Agents
keywords: Androgen deprivation therapy; Brachytherapy; Prostate cancer; Survival