Precision Timing: Finding the 'Goldilocks' Zone for Prostate Cancer Therapy

Treating localised prostate cancer often involves a dual attack: radiotherapy combined with androgen deprivation therapy (ADT). ADT works by starving the tumour of testosterone, the hormone that fuels its growth. However, a comprehensive meta-analysis involving 10,266 patients across 13 randomised phase 3 trials has revealed that more is not always better.

Researchers analysed decades of data to determine the optimal treatment length. They found that whilst extending ADT reduces the risk of distant metastasis—where cancer spreads to other body parts—and improves cancer-specific survival, the estimated benefits diminish significantly beyond 9 to 12 months. Crucially, long-term use was linked to a near-linear increase in mortality from causes unrelated to the cancer itself.

The findings support a stratified approach: zero months of ADT for patients with a single intermediate-risk factor, six months for those with multiple factors, and twelve months for high-risk cases. This tailored strategy aims to maximise cancer suppression whilst minimising the toxicity associated with prolonged hormone deprivation.