A 65-year-old man with high-risk prostate cancer (PSA 28 ng/mL, Gleason 4+4=8, T3a on MRI) is to receive definitive radiotherapy. Which adjuvant/concurrent systemic therapy reduces prostate cancer-specific mortality most significantly?

• A Short-term androgen deprivation therapy (6 months ADT)
• B Docetaxel chemotherapy concurrent with radiotherapy
• C Abiraterone + prednisone concurrent with radiotherapy
• D Long-term ADT (2–3 years) combined with radiotherapy ✓

Explanation

EORTC 22863 and RTOG 92-02 trials established that long-term ADT (2–3 years) combined with radiotherapy significantly improves overall survival and cancer-specific survival in high-risk prostate cancer compared with radiotherapy alone or short-term ADT. The STAMPEDE and DART 01/05 trials further support extended ADT duration. The PEACE-1 and STAMPEDE abiraterone arms showed benefit in de novo metastatic disease, not non-metastatic high-risk disease with definitive RT. Docetaxel concurrent with RT is not standard outside trials.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.