Goldilocks.

Do you wait 2-3 months after initiating ADT to start radiation for intermediate and high risk prostate cancer? The debate over the timing of ADT with radiation heated up when a recent meta-analysis of RTOG 9413 and the Ottawa 0101 trial found that short-term concurrent and adjuvant ADT was associated with better treatment outcomes than neoadjuvant and concurrent ADT. Cue provocative NCDB analyses. This NCDB study of men with high-risk prostate cancer treated between 2004 and 2015 with definitive radiation and ADT found that 10-year overall survival was significantly higher for men who received ADT 8-11 weeks prior to radiation (51.2%) compared to those who had shorter (49.9%) or longer duration neoadjuvant ADT (46.9%). This is in contrast to another recent NCDB study that found no difference in survival based on ADT timing among men with intermediate and high risk prostate cancer. Whatever camp you're in, you should be able to find NCDB data to support your argument. | McCall, Adv Radiat Oncol 2021