title: Survival outcomes of radiotherapy with or without androgen-deprivation therapy for patients with intermediate-risk prostate cancer using the National Cancer Data Base.
abstract: OBJECTIVE
  Presently no reported prospective, randomized trials have clearly defined the role of androgen-deprivation therapy (ADT) for patients with intermediate-risk prostate cancer in the setting of radiation therapy (RT) dose escalation. This study׳s objective was to evaluate the survival benefit of adding ADT to high-dose RT for patients with intermediate-risk prostate cancer using the National Cancer Data Base.
  
  
  METHODS
  The National Cancer Data Base was queried for patients with intermediate-risk prostate cancer treated from 2004 to 2006, with available data for Gleason Score, prostate-specific antigen, TNM staging, and receipt of radiation and ADT. Start of RT was within 1 to 180 days of ADT; radiation included external beam alone (≥70Gy) or external beam RT plus brachytherapy boost. Overall survival was evaluated using multivariate (MVA) Cox regression and propensity score-matched (PSM) analyses.
  
  
  RESULTS
  A total of 14,126 patients were included of which 7,568 (53.6%) received no ADT and 6,558 (46.4%) received ADT. Median follow-up was 85.8 months (6.0-119.9mo). Median RT dose was 75.6Gy in 42 fractions. Under MVA, the addition of ADT for patients with intermediate-risk prostate cancer had no overall survival benefit compared with RT alone (hazard ratio [HR] = 0.97, P = 0.316). PSM also confirmed no survival benefit with the addition of ADT for the entire intermediate-risk cohort (HR = 0.98, P = 0.560). On subset analysis, those with 3 intermediate-risk factors had a survival benefit with the addition of ADT on both MVA (HR = 0.69, P = 0.037) and PSM (HR = 0.61, P = 0.026). Limitations include retrospective design and incomplete data on the type of ADT and duration.
  
  
  CONCLUSIONS
  With the exception of men who present with all 3 intermediate-risk factors, a significant association with decreased all-cause mortality risk and ADT was not observed for patients with intermediate-risk prostate cancer.
authors.affiliation: Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO. Electronic address: arya.amini@ucdenver.edu.
authors.forename: Arya
authors.initials: A
authors.lastname: Amini
authors.affiliation: Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO.
authors.forename: Chad G
authors.initials: CG
authors.lastname: Rusthoven
authors.affiliation: Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO.
authors.forename: Bernard L
authors.initials: BL
authors.lastname: Jones
authors.affiliation: Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO.
authors.forename: Hirotatsu
authors.initials: H
authors.lastname: Armstrong
authors.affiliation: Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO.
authors.forename: David
authors.initials: D
authors.lastname: Raben
authors.affiliation: Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO.
authors.forename: Brian D
authors.initials: BD
authors.lastname: Kavanagh
mesh_terms: D000328:Adult; D000368:Aged; D000726:Androgen Antagonists / Q000627:therapeutic use; D016208:Databases, Factual; D006801:Humans; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy / Q000628:therapy*; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology
chemical_list: D000726:Androgen Antagonists
keywords: Androgen-deprivation therapy; Hormones; Intermediate-risk; NCDB; Prostate cancer; Radiation therapy