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To the Editor: In the study by Dr D’Amico and colleagues¹ an improvement in survival and freedom from salvage therapy was observed with androgen suppression therapy (AST) plus radiation therapy (RT). While there are patients who benefit from AST under certain conditions, what still remains unclear is which patients (intermediate- vs high-risk) should be treated with short-term (6 months) AST plus RT vs long-term (>2 years) AST plus RT, and whether any AST is necessary in the setting of RT dose escalation.

Eligibility for inclusion in this study required a pretreatment prostate-specific antigen (PSA) level of 10 to 40 ng/mL or a Gleason score of 7 or higher. Low-risk patients were ineligible unless they had endorectal magnetic resonance imaging evidence of extracapsular extension (clinical T3). A number of patients in this trial had high-risk features, ie, a PSA level greater than 20 ng/mL, a Gleason score of 8 . . . [Full Text of this Article]

Eric M. Horwitz, MD
eric.horwitz@fccc.edu

Steven J. Feigenberg, MD; Alan Pollack, MD, PhD; Gerald E. Hanks, MD
Department of Radiation Oncology

Robert G. Uzzo, MD
Department of Urologic Oncology
Fox Chase Cancer Center
Philadelphia, Pa

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