RTOG Protocol 92-02: A phase II trial of the use of long term total androgen suppression following neoadjuvant hormonal cytoreduction and radiotherapy in locally advanced carcinoma of the prostate
Presenter: Gerald E. Hanks
Controversy exists on the integration of hormonal therapy for the treatment of locally advanced prostate cancer. This trial was designed to determine if long term androgen ablation is superior to short term ablation.
Materials and Methods:
- 1554 patients with locally advanced prostate cancer (T2c-T4) and a PSA of < 150 ng/ml were enrolled on this trial
- All patients received 4 months of Goserelin and Eulixin two months before radiation and 2 months during radiation.
- Patients were then randomized to no additional hormonal therapy versus 2 years of long term hormonal therapy.
- Radiation consisted of 45-50 Gy to a large pelvic field to treat the lymph node regions followed by a boost to the prostate to a total dose of 65-70 Gy.
- Local progression was 5.6% versus 11.8%, biochemical progression was 22% vs 47%, and the distant metastases rate was 10% verus 16% all in favor of long term hormonal therapy.
- Overall survival at 5 years was not signifantly different between the groups 3) A subgroup analysis of patients with Gleason Score 8-10 showed improvement in disease specific survival of 89% versus 78% and overall survival of 80% versus 70%.
- Long term androgen deprivation is better than short term blockade for locally advanced prostate cancer.
- Currently, there is no role for short term ablation.
- Increase doses of radiation should be explored to further improve on these results.
- Patients with locally advanced prostate cancer should receive hormones for longer duration (>2 yrs) when combined with radiation therapy
- Monotherapay is no longer standard therapy
- Radiation therapy combined with long term androgen ablation is the standard of care for locally advanced prostate cancer.