MDT (multi-disciplinary team) guidance for managing prostate cancer

Clinical evidence
• Adjuvant androgen suppression immediately after radical radiotherapy has been shown to
significantly increase OS, PFS, and significantly reduce local progression, distant metastases and
biochemical progression in several large randomised studies.
• Bolla et al. (EORTC 22863) randomised 415 patients with locally advanced non-metastatic prostate
cancer (T1−4, Nx, M0) to receive either radiotherapy with immediate goserelin 3.6 mg therapy
(every 4 weeks for 3 years) plus cyproterone acetate (CPA) during the first month of treatment for
disease flare (n=207) or radiotherapy alone (n=208). 91
o After a mean follow-up of 66 months, the 5-year DFS rate was 74% versus 40% for the
combined and EBRT alone groups, respectively (p=0.001).
o Furthermore, the corresponding OS and cancer-specific survival rates at 5 years were 78% and
62% (p=0.0002), while the cancer-specific survival rates were 94% versus 79%.
o A further analysis of this study with a median follow-up of 9.1 years reported 192 deaths
(112 in radiotherapy alone and 80 in the combined treatment arm). 92
o The addition of 3 years of ADT increased the 10-year OS from 39.8% to 58.1% (HR 0.60;
95%CI: 0.45−0.80; p=0.0004), clinical PFS from 22.7% to 47.7% (HR 0.42; 95%CI: 0.33−0.55;
p