Receiving NADT for 6 Months Doesn’t Impact Outcomes in Intermediate-Risk Prostate Cancer After EBRT

Despite clinical trial findings, real-world evidence shows adding 6 months of neoadjuvant deprivation therapy (NADT) to external-beam radiation therapy (EBRT) for patients with intermediate-risk prostate cancer did not improve prostate cancer–specific survival or overall survival, explained Barry Goy, MD, a radiation oncologist at Kaiser Permanente Los Angeles Medical Center.

Goy presented the findings of a retrospective analysis of 15-year outcomes of patients with intermediate-risk prostate cancer who were treated with EBRT with or without NADT.

This transcript has been lightly edited; captions were auto-generated.

Transcript

Your 15-year study found it's unclear if 6 months of neoadjuvant deprivation therapy added to external-beam radiation therapy improves survival of intermediate-risk prostate cancer. Are there any characteristics of patients who might benefit more and justify the use of neoadjuvant deprivation therapy?

Patients with visible metastases. Certainly, we are seeing more visible metastases these days than we used to because of the PSMA [prostate-specific membrane antigen] PET scan. I think in the older days—for the majority of my career—bone scan or CTs didn't pick up much of anything, so it was just a number. Just because you see a visible metastasis on PSMA PET scan that may not be so bad, because it's a very sensitive scan. It's almost closer to the PSA [prostate-specific antigen] level, as opposed to traditional imaging.

I think what's happening as a result of the PSMA PET scan, people are being treated more aggressively now than they used to be, even though we may not have clear evidence that we're improving prostate cancer–specific survival.

Would more information provide a more accurate picture of whether neoadjuvant deprivation therapy does provide a benefit?

I personally think 6 months of neoadjuvant deprivation therapy and additional radiation is not going to reduce prostate cancer–specific mortality. That's my personal opinion looking at the data—despite what the randomized trials show—and what I've seen over the years from my clinical experience. One shot [of therapy] to improve prostate cancer–specific survival that much [compared with no NADT] just really doesn't make sense to me.