Absolute Benefit of Androgen Deprivation Therapy With Radiotherapy for Localized Prostate Cancer
An integrated model combining STAR-CAP cancer-specific risk, OCCAM other-cause mortality risk, and MARCAP efficacy estimates shows wide variation in absolute benefit from androgen deprivation therapy within NCCN risk groups. Applied to 5468 PLCO prostate cancer patients, adding short-term ADT to radiotherapy in unfavorable intermediate-risk disease gave a median 10-year distant metastasis ARR of 4% (range <1% to almost 15%), while prolonging ADT in high-risk disease gave a median ARR of 9% (0.4%-17.2%). The model provides individualized estimates to support treatment discussions rather than uniform group-level recommendations.
Why it matters: Quantifies how little absolute benefit some men within standard risk groups derive from ADT, informing individualized decisions.