In a pooled analysis of 12 randomised trials #SANDSTORM, to address the sequencing of androgen-deprivation therapy (ADT) with radiotherapy, concurrent/adjuvant #ADT was associated with improved outcomes compared to neoadjuvant/concurrent #ADT in patients with non-metastatic prostate cancer getting 4-6 months of ADT (n=7,409).

After a median follow-up of 10.2 years, results showed improved metastasis-free survival (10-year benefit 8.0%; HR: 0.65; P < .0001), prostate cancer–specific mortality (HR: 0.30; P < .0001), and OS (HR: 0.69; P = .0001) favouring concurrent/adjuvant sequencing in the overall cohort.

Additionally, it was found that the impact of ADT sequencing on outcomes is dependent on the radiotherapy field size (Prostate-only versus WPRT). There was a significant improvement of the outcomes among patients receiving prostate-only RT in the concurrent/adjuvant group compared with the neoadjuvant/concurrent group; however, that was not significant for those received whole-pelvis RT. These superior outcomes with concurrent/adjuvant compared with neoadjuvant/concurrent ADT coupled with PORT, but not with WPRT are not yet explained.