Dr Goy on Unclear Survival Benefit With Neoadjuvant ADT Plus EBRT in Intermediate-Risk Prostate Cancer

“Close to half the patients experienced a biochemical failure, which is quite significant. In that context, we would [expect to] see a significant decrement in terms of reduced PCSS. But at 10 years, the percentage of patients who died of prostate cancer was close to 4%; when we looked over a period of 15 years, it was approximately 9%.”

Barry W. Goy, MD, physician, Radiation Oncology, Kaiser Permanente, discusses the potential benefit of adding 6 months of neoadjuvant androgen deprivation therapy (ADT) to external beam radiation therapy (EBRT) for patients with intermediate-risk prostate cancer, according to a retrospective analysis of 15-year outcomes.

Data presented at the 2025 Genitourinary Cancers Symposium indicate that, despite 48% and 51% of patients experiencing biochemical failure after treatment with short-term neoadjuvant ADT with EBRT vs EBRT alone, respectively, prostate cancer–specific survival (PCSS) remained favorable over 15 years of follow-up. At 10 years, approximately 4% of patients died from prostate cancer; by 15 years, this percentage increased to 9% (P = .67), reflecting a relatively low mortality rate from prostate cancer despite biochemical recurrence.

Analyzing results from prior randomized studies investigating the addition of 6 months of ADT to radiation therapy highlighted further discrepancies in outcomes, Goy asserts. Although biochemical failure rates were lower in the randomized trials due to shorter follow-up periods of 7 to 10 years, PCSS in the radiation-alone arms of these studies was notably worse, he states. For patients receiving combined ADT and radiation therapy in these trials, PCSS outcomes were comparable to those observed in the current analysis, Goy notes.

An apparent discrepancy exists between these results and those from prior randomized trials, such as the Harvard study, where approximately 19% of patients in the control arm died from prostate cancer (P = .02). This divergence raises questions about why patients in the control arms of other randomized studies exhibit poorer PCSS outcomes.

Goy noted that the lower prostate cancer mortality rate observed in this long-term analysis aligns more closely with his own clinical experience, suggesting potential differences in patient selection, treatment delivery, or follow-up protocols across institutions. These findings underscore the durability of PCSS with radiation therapy, although the benefit of adding 6 months of short-term ADT remains unclear, he emphasizes. Accordingly, future analyses are needed to better understand the factors contributing to variable outcomes in randomized trials, Goy concludes.