The Influence of Age and Comorbidity on the Benefit of Adding Androgen Deprivation to Dose-escalated Radiation in Men With Intermediate-risk Prostate Cancer

Am J Clin Oncol. 2016 Aug;39(4):368-73. doi: 10.1097/COC.0000000000000071.


Objective: Androgen deprivation therapy (ADT) can improve outcomes for men with intermediate-risk prostate cancer (IR-PrCa) receiving external-beam radiotherapy (EBRT). Older men and men with significant comorbidity may be more susceptible to the harms of ADT, therefore we aimed to determine whether these men benefit from ADT.

Methods: The adult comorbidity evaluation-27 index categorized severity of comorbidity in 636 men treated for IR-PrCa with dose-escalated EBRT (>75 Gy). The cohort was dichotomized at median age of 70. Multivariate Cox proportional hazard analysis evaluated the association of ADT with failure-free survival (FFS) for each age and comorbidity subgroup.

Results: A total of 48% of men were 70 years and above. After adjustment for tumor characteristics, the addition of ADT to EBRT was associated with improved FFS for both men below 70 years of age (adjusted hazard ratio [AHR] 0.44; 95% confidence interval [CI], 0.19-0.99; P=0.046) and men 70 years and above (AHR 0.23; 95% CI, 0.06-0.91; P=0.035). ADT improved FFS for men below 70 years who had no or mild comorbidity (AHR 0.25; 95% CI, 0.09-0.73; P=0.011) but not for men below 70 years who had moderate or severe comorbidity (AHR 1.62; 95% CI, 0.35-7.49; P=0.537). Similarly, in men 70 years and above, there was a trend for improved FFS with ADT in healthy men (AHR 0.10; 95% CI, 0.01-1.08; P=0.058) but not in men with moderate to severe comorbidity (AHR 0.38; 95% CI, 0.06-2.56; P=0.318).

Conclusions: The addition of ADT to dose-escalated EBRT can improve outcomes for both younger and older men with IR-PrCa. This benefit was more pronounced in healthy men.

MeSH terms

  • Age Factors
  • Aged
  • Androgen Antagonists / therapeutic use*
  • Comorbidity*
  • Disease-Free Survival
  • Gonadotropin-Releasing Hormone / therapeutic use*
  • Humans
  • Male
  • Middle Aged
  • Neoplasm Grading
  • Proportional Hazards Models
  • Prostatic Neoplasms / epidemiology*
  • Prostatic Neoplasms / pathology
  • Prostatic Neoplasms / therapy*
  • Radiotherapy Dosage
  • Risk Factors
  • Severity of Illness Index


  • Androgen Antagonists
  • Gonadotropin-Releasing Hormone