Duration of Androgen Suppression with Postoperative Radiotherapy (DADSPORT) for Nonmetastatic Prostate Cancer: A Collaborative Systematic Review and Meta-analysis of Aggregate Data

Sarah Burdett¹, David J Fisher², Jayne F Tierney², Adrian D Cook³, Daniel E Spratt⁴, James J Dignam⁵, Wendy F Seiferheld⁶, Amar U Kishan⁷, Yilun Sun⁸, Sylvie Chabaud⁹, Jason A Efstathiou¹⁰, Christopher C Parker¹¹, Alan Pollack¹², Paul Sargos¹³, Igor Latorzeff¹⁴, Meryem Brihoum¹⁵, Charles N Catton¹⁶, Noel W Clarke¹⁷, Felix Y Feng¹⁸, Theodore G Karrison¹⁹, Pascal Pommier²⁰, Howard M Sandler²¹, Matthew R Sydes²², Claire L Vale²; DADSPORT Meta-analysis Collaboration

Affiliations

¹ MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London, UK. Electronic address: sarah.burdett@ucl.ac.uk.
² MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London, UK.
³ MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London, UK; Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK.
⁴ Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH, USA.
⁵ NRG Oncology Statistics and Data Management Center, Philadelphia, PA, USA.
⁶ NRG Oncology, Philadelphia, PA, USA.
⁷ Radiation Oncology, Jonsson Comprehensive Cancer Center at UCLA, Los Angeles, CA, USA.
⁸ Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA.
⁹ Clinical Research Unit, Centre Léon Bérard, Lyon, France.
¹⁰ Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
¹¹ Department of Urology, The Royal Marsden Hospital (Sutton) - NHS Foundation Trust, Sutton, UK; Institute of Cancer Research, Sutton, UK.
¹² Department of Radiation Oncology, Miller School of Medicine and Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA.
¹³ Department of Radiotherapy, Institute Bergonié, Bordeaux, France.
¹⁴ Department of Radiation Oncology, Clinique Pasteur, Toulouse, France.
¹⁵ R&D, Unicancer, Paris, France.
¹⁶ Radiation Oncology Department, Princess Margaret Cancer Center, Toronto, Canada.
¹⁷ Department of Urology, The Christie and Salford Royal NHS Foundation Trusts, Manchester, UK.
¹⁸ Department of Radiation Oncology, University of California at San Francisco, San Francisco, CA, USA.
¹⁹ Department of Public Health Sciences, University of Chicago, Chicago, IL, USA.
²⁰ Department of Radiation Oncology, Centre Léon Bérard, Lyon, France.
²¹ Cedars Sinai Medical Center, Los Angeles, CA, USA.
²² MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London, UK; Transformation Directorate, NHS England, London, UK.

PMID: 40571441
DOI: 10.1016/j.eururo.2025.05.013

Free article

Duration of Androgen Suppression with Postoperative Radiotherapy (DADSPORT) for Nonmetastatic Prostate Cancer: A Collaborative Systematic Review and Meta-analysis of Aggregate Data

Sarah Burdett et al. Eur Urol. 2025 Sep.

Free article

. 2025 Sep;88(3):277-290.

doi: 10.1016/j.eururo.2025.05.013. Epub 2025 Jun 26.

Authors

Affiliations

¹ MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London, UK. Electronic address: sarah.burdett@ucl.ac.uk.
² MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London, UK.
³ MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London, UK; Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK.
⁴ Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH, USA.
⁵ NRG Oncology Statistics and Data Management Center, Philadelphia, PA, USA.
⁶ NRG Oncology, Philadelphia, PA, USA.
⁷ Radiation Oncology, Jonsson Comprehensive Cancer Center at UCLA, Los Angeles, CA, USA.
⁸ Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA.
⁹ Clinical Research Unit, Centre Léon Bérard, Lyon, France.
¹⁰ Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
¹¹ Department of Urology, The Royal Marsden Hospital (Sutton) - NHS Foundation Trust, Sutton, UK; Institute of Cancer Research, Sutton, UK.
¹² Department of Radiation Oncology, Miller School of Medicine and Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA.
¹³ Department of Radiotherapy, Institute Bergonié, Bordeaux, France.
¹⁴ Department of Radiation Oncology, Clinique Pasteur, Toulouse, France.
¹⁵ R&D, Unicancer, Paris, France.
¹⁶ Radiation Oncology Department, Princess Margaret Cancer Center, Toronto, Canada.
¹⁷ Department of Urology, The Christie and Salford Royal NHS Foundation Trusts, Manchester, UK.
¹⁸ Department of Radiation Oncology, University of California at San Francisco, San Francisco, CA, USA.
¹⁹ Department of Public Health Sciences, University of Chicago, Chicago, IL, USA.
²⁰ Department of Radiation Oncology, Centre Léon Bérard, Lyon, France.
²¹ Cedars Sinai Medical Center, Los Angeles, CA, USA.
²² MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London, UK; Transformation Directorate, NHS England, London, UK.

PMID: 40571441
DOI: 10.1016/j.eururo.2025.05.013

Abstract

Background and objective: To better understand the role of hormone therapy (HT) with postoperative radiotherapy (RT) for nonmetastatic prostate cancer, the DADSPORT Collaboration planned a systematic review and meta-analysis of aggregate data from randomised controlled trials (RCTs).

Methods: RCTs evaluating HT with postoperative RT in people with nonmetastatic prostate cancer were identified. Methods were prespecified prior to results of recent trials being known (CRD42022325769). The primary outcome was overall survival (OS); metastasis-free survival (MFS) and prostate cancer-specific survival (PCSS) were the secondary outcomes. Summary results, including those by prespecified participant subgroups, were obtained from investigators and combined across trials using a fixed-effect meta-analysis. Sensitivity and network meta-analyses evaluated the consistency of findings.

Key findings and limitations: Five RCTs (six trial comparisons, 4411 participants; 96% of all eligible) were included in the primary analysis. There was no clear evidence that OS was improved with HT (hazard ratio [HR] = 0.86, 95% confidence interval [CI] = 0.74-1.00, p = 0.057; absolute effect 2% [0-3.5%] at 8 yr) or that effects varied by HT duration (p = 0.6). Any benefit of HT on OS appears to be confined to people with higher pre-RT prostate specific antigen levels (p = 0.07) and CAPRA-S scores (p = 0.09). HT significantly improved MFS (HR = 0.78, 95% CI = 0.69-0.88, p < 0.001) and PCSS (HR = 0.61, 95% CI = 0.47-0.79, p < 0.001), with 4% absolute improvements for both outcomes at 8 yr.

Conclusion and clinical implications: Short- or long-course HT after postoperative RT improves MFS and PCSS. Observed improvements in OS are small and may be limited to people with higher-risk factors.

Keywords: Hormone therapy; Meta-analysis; Prostate cancer; Radiotherapy.

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Duration of Androgen Suppression with Postoperative Radiotherapy (DADSPORT) for Nonmetastatic Prostate Cancer: A Collaborative Systematic Review and Meta-analysis of Aggregate Data

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Duration of Androgen Suppression with Postoperative Radiotherapy (DADSPORT) for Nonmetastatic Prostate Cancer: A Collaborative Systematic Review and Meta-analysis of Aggregate Data

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Medical