Efficacy of androgen deprivation therapy (ADT) in combination with radiation therapy, compared to ADT alone in patients with high-risk prostate cancer: an updated systematic review and meta-analysis
Abstract
Androgen deprivation therapy (ADT) has long been a cornerstone of treatment for patients with locally advanced or metastatic hormone-sensitive prostate cancer. The efficacy of ADT plus radiotherapy (RT) compared to ADT alone remains unclear due to conflicting results in existing literature. The study aimed to systematically evaluate the effectiveness of ADT combined with RT versus ADT alone in patients with prostate cancer (clinically node positive, locally advanced disease, metastatic disease), focusing on overall survival (OS), prostate-specific mortality (PSM), progression-free survival (PFS), and the risk of complications. A comprehensive search of PubMed, Embase, Web of Science, and Scopus was conducted between 1st January 2000 and 15th October 2024 to identify studies comparing ADT alone to ADT combined with RT. Hazard ratios (HRs) and relative risks (RRs) with 95% confidence intervals (CIs) were calculated for the outcomes. The certainty of the evidence was assessed using the standard GRADE approach. A total of 8 studies met the inclusion criteria (6 RCTs and 2 cohort studies). These studies included 18,456 patients. The combination of ADT and RT significantly improved OS (HR = 0.75, 95% CI, 0.63, 0.90), PFS (HR = 0.41, 95% CI, 0.20, 0.84), and reduced PSM (HR = 0.52, 95% CI, 0.34, 0.78) compared to ADT alone. Subgroup analysis showed greater OS (HR = 0.66, 95% CI, 0.59, 0.75) and PSM (HR = 0.43, 95% CI, 0.39, 0.49) in patients with locally advanced or node-positive…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 18,456 participants or records.
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