title: Androgen Deprivation Therapy Use in the Setting of High-dose Radiation Therapy and the Risk of Prostate Cancer-Specific Mortality Stratified by the Extent of Competing Mortality.
abstract: The addition of androgen deprivation therapy (ADT) to radiation therapy (RT) is the standard of care for men with intermediate- and high-risk prostate cancer (PC). However, whether competing mortality (CM) affects the ability of ADT to improve, survival remains unanswered.
  
  
  
  We calculated a CM risk score using a Fine-Gray semiparametric model that included age and cardiometabolic comorbidities from a cohort of 17,669 men treated with high-dose RT with or without supplemental ADT for nonmetastatic PC. Fine and Gray competing risk regression analysis was used to assess whether ADT reduced the risk of PC-specific mortality for men with a low versus a high risk of CM among the 4550 patients within the intermediate- and high-risk cohort after adjustment for established PC prognostic factors, year of treatment, site, and ADT propensity score.
  
  
  
  After a median follow-up of 8.4 years, 1065 men had died, 89 (8.36%) of PC. Among the men with a low CM score, ADT use was associated with a significant reduction in the risk of PC-specific mortality (adjusted hazard ratio 0.35, 95% confidence interval 0.14-0.87, P=.02) but was not for men with high CM (adjusted hazard ratio 1.33, 95% confidence interval 0.77-2.30, P=.30).
  
  
  
  Adding ADT to high-dose RT appears to be associated with decreased PC-specific mortality risk in men with a low but not a high CM score. These data should serve to heighten awareness about the importance of considering competing risks when determining whether to add ADT to RT for older men with intermediate- or high-risk PC.
authors: Harvard Radiation Oncology Program, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts. Electronic address: brose44@gmail.com.
authors: Brent S
authors: BS
authors: Rose
authors: Department of Statistics, University of Connecticut, Storrs, Connecticut.
authors: Ming-Hui
authors: MH
authors: Chen
authors: Department of Statistics, University of Connecticut, Storrs, Connecticut.
authors: Jing
authors: J
authors: Wu
authors: Prostate Cancer Foundation of Chicago, Westmont, Illinois.
authors: Michelle H
authors: MH
authors: Braccioforte
authors: Prostate Cancer Foundation of Chicago, Westmont, Illinois.
authors: Brian J
authors: BJ
authors: Moran
authors: 21st Century Oncology, Inc, Fort Myers, Florida.
authors: Daniel E
authors: DE
authors: Doseretz
authors: 21st Century Oncology, Inc, Fort Myers, Florida.
authors: Michael J
authors: MJ
authors: Katin
authors: 21st Century Oncology, Inc, Fort Myers, Florida.
authors: Rudolf H
authors: RH
authors: Ross
authors: 21st Century Oncology, Inc, Fort Myers, Florida.
authors: Sharon A
authors: SA
authors: Salenius
authors: Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts.
authors: Anthony V
authors: AV
authors: D'Amico
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000726:Androgen Antagonists / Q000627:therapeutic use*; D001918:Brachytherapy; D002423:Cause of Death; D003131:Combined Modality Therapy / Q000401:mortality; D015897:Comorbidity; D016001:Confidence Intervals; D016208:Databases, Factual; D005500:Follow-Up Studies; D000067495:Healthcare Failure Mode and Effect Analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D057216:Propensity Score; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000188:drug therapy* / Q000401:mortality* / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D012044:Regression Analysis; D013997:Time Factors
chemical_list: D000726:Androgen Antagonists; D017430:Prostate-Specific Antigen