Make the time fit the crime.

What’s the optimal duration of androgen deprivation therapy (ADT) for men with high-risk prostate cancer? Possible sentencing is 18 months to life. This patient-level meta-analysis of six randomized trials tries to answer that question for men with grade group 4 (aka Gleason 8) and grade group 5 (aka Gleason 9-10) prostate cancers. The durations of ADT were short-term (4-6 months), long-term (28-36 months) and lifelong (or indefinite). The findings are, well, confusing. For grade group 4, short- and long-term ADT improved survival over radiation alone, but not lifelong ADT. For grade group 5, the opposite was true with only lifelong ADT improving overall survival. What’s largely to blame here is a limited sample size (hundreds) for a question that likely requires thousands of participants to answer. TBL: The optimal duration of ADT may be in some way proportional to the grade of disease. | Kishan, JAMA Oncol 2018