About time.

Correspondence (1, 2) in JCO questions whether the results of a recent meta-analysis of ADT timing for men with localized prostate cancer should be “practice changing.”  As a reminger, the meta-analysis of the Ottawa 0101 and RTOG 9413 trials found that sequencing of ADT concurrent and adjuvant to RT was associated with better PFS, lower biochemical failure, and fewer distant metastases than sequencing neoadjuvant. Sure it’s a meta-analysis of just two trials, one of which was RTOG 9413. But the problem is that the very reason both trials were conducted was because there is clinical equipoise when it comes to ADT and RT sequencing. Therefore, there’s no gold standard for when to start ADT and RT in relation to each other. So even if these trials and their meta-analysis don’t convince you that concurrent and adjuvant ADT is beneficial, they at least “emphasize that a delay in initiating RT to allow receipt of neoadjuvant ADT is unnecessary and does not reduce long-term toxicity.” | Hocht and Sundar, J Clin Oncol 2021