title: Comparison of neoadjuvant vs concurrent/adjuvant androgen deprivation in men with high-risk prostate cancer receiving definitive radiation therapy.
abstract: OBJECTIVE
  It is unknown whether there is a benefit to starting androgen deprivation therapy (ADT) prior to rather than concurrently with definitive radiation therapy in men with high-risk prostate cancer. We studied the National Cancer Data Base to determine whether the timing of ADT impacts survival.
  
  
  METHODS
  Men diagnosed with high-risk prostate adenocarcinoma who received external beam radiation therapy (EBRT) to a dose of 70-81 Gy along with ADT from 2004-2011 were included. Those who started ADT 42-90 days before EBRT were identified as having received neoadjuvant hormonal therapy (N-HT) and those who received ADT from 14 days before their radiation until 84 days after the start of EBRT were categorized as receiving concurrent/adjuvant treatment (C-HT). We used the log-rank test to compare Kaplan-Meier survival curves and multivariable Cox regression to assess the impact of covariables on overall survival (OS).
  
  
  RESULTS
  Among 11,491 included patients, those receiving N-HT were 1 year older (p<0.001) and more likely to have Gleason 8-10 disease (p = 0.01) and cT3-4 disease (p = 0.002). Men receiving N-HT had a 5-year and median OS of 80.6% and 111.4 months, respectively, compared to 78.3% and 108.9 months, respectively, in those receiving C-HT (p = 0.03). This benefit remained significant on multivariable analysis (hazard ratio 0.86, 95% confidence interval 0.77-0.96, p = 0.008). Duration of ADT was not available to report.
  
  
  CONCLUSIONS
  External beam radiation therapy with N-HT was associated with improved overall survival compared to C-HT. This study is hypothesis-generating and further studies are needed to best qualify the sequencing of hormone therapy with the duration of treatment.
authors.affiliation: Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY - USA.|Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, NY - USA.
authors.forename: Anna
authors.initials: A
authors.lastname: Lee
authors.affiliation: Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, NY - USA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Becker
authors.affiliation: Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY - USA.|Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, NY - USA.
authors.forename: Ariel J
authors.initials: AJ
authors.lastname: Lederman
authors.affiliation: Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY - USA.|Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, NY - USA.
authors.forename: Virginia W
authors.initials: VW
authors.lastname: Osborn
authors.affiliation: Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY - USA.|Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, NY - USA.
authors.forename: Meng S
authors.initials: MS
authors.lastname: Shao
authors.affiliation: Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY - USA.|Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, NY - USA.
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Wong
authors.affiliation: Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY - USA.|Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, NY - USA.
authors.forename: David
authors.initials: D
authors.lastname: Schwartz
authors.affiliation: Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY - USA.|Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, NY - USA.
authors.forename: David
authors.initials: D
authors.lastname: Schreiber
mesh_terms: D000368:Aged; D000726:Androgen Antagonists / Q000008:administration & dosage*; D018572:Disease-Free Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal; D016896:Treatment Outcome
chemical_list: D000726:Androgen Antagonists