Determining Best Candidates for Concomitant ADT in Prostate Cancer

The utility of concomitant androgen deprivation therapy (cADT) in patients with prostate cancer with clinical relapse at prostate-specific membrane antigen (PSMA) positron emission tomography (PET) is unknown.

A study from Elio Mazzone, MD, PhD, and colleagues, presented at the 2024 American Urological Association Annual Meeting, sought to determine the most favorable candidates for cADT among patients who are PSMA PET positive following primary biochemical recurrence (pBCR) or secondary biochemical recurrence (sBCR) who receive metastasis-directed therapy (MDT).

Researchers analyzed the data of 383 men with prostate cancer who underwent PSMA PET staging for BCR following radical prostatectomy (RP) or radiotherapy. Of the patients demonstrating positive PSMA PET, researchers included only those who underwent MDT.

The primary end point was clinical recurrence (CR), which investigators characterized as new metastases detected through imaging following initial PSMA PET.

Of the patients, 78 (65%) were PSMA PET positive and underwent MDT as well as cADT. Dr. Mazzone and colleagues noted no differences across ADT cohorts (P≥.1). Throughout the patient groups, 37 demonstrated disease progression.

Following Kaplan-Meier analysis, the 2-year CR-free survival rate was 75%. Multivariable Cox regression analyses found that patients with sBCR experienced increased CR rates (hazard ratio [HR], 2.87; P<.001).

After stratification, patients with ≥2 pelvic nodal spots (HR, 0.78; P=.002) and those with distant extra-pelvic spots (HR, 0.40; P=.03) were found to benefit from ADT, not considering other disease characteristics. Researchers confirmed the results following stratification according to pBCR versus sBCR.

“Patients with ≥2 nodal or distant spots represent the ideal candidates for intensification treatment with ADT during MDT, either in case of pBCR or sBCR after RP,” researchers wrote.