Evolving Paradigm of Radiotherapy for High-Risk Prostate Cancer: Current Consensus and Continuing Controversies

Table 2

Randomized trials examining the addition of ADT to radiation for high-risk patients.

Trial	Study cohort	Median; follow-up	Trial arms	Outcomes
RTOG 85-31 [11, 12]	945 patients T3 (82%) or N1 (18%)	7.6 years	RT versus RT + ADT; (44–46 Gy to whole pelvis; 20–25 Gy boost to prostate); ADT: goserelin at least 2 years, preferably until progression	10-year OS (39% versus 49%, ); 10-year DSS (78% versus 84%, ); Overall survival benefit limited to patients with Gleason 7–10
RTOG 86-10 [13–15]	456 patients T2-T4, N0-1 with “bulky” disease (palpable 25 cm^2)	11.9 years	RT versus RT + ADT; (44–46 Gy to whole pelvis; 20–25 Gy boost to prostate); ADT: 4 months’ goserelin + flutamide, starting 2 months prior to RT	10-year OS (34% versus 43%, ); 10-year DSS (23% versus 36%, ); Subset analyses at 8 years showed that benefit was confined to Gleason 2–6 patients. No benefit to ADT in Gleason 7–10
TROG 96-01 [16]	802 patients; T2b-T4N0	10.6 years	RT alone versus RT + 3 mo. ADT versus RT + 6 mo.; (66 Gy, no pelvic node treatment); ADT: goserelin + flutamide given neoadjuvantly	At 10 years, addition of 6 months’ ADT improved; 10-year OS (70.8% versus 57.5%, ); 10-year DSS (48% versus 23%, )
EORTC 22863; [17, 18]	415 patients; T1-2N0 grade 3 or T3-4N0-1	9.1 years	RT versus RT + 3 years’ ADT; (50 Gy to pelvis, 20 Gy boost); ADT: 1 month’ cyproterone acetate, goserelin 3 years starting with RT	10-year OS (40% versus 58%, ); 10-year DSS (10% versus 30%, )

OS: overall survival, DSS: disease-specific survival.