Salvage radiotherapy combined with androgen deprivation therapy improves biochemical progression-free survival in prostate cancerCombined Therapy Shows Better Outcomes for Prostate Cancer Patients

Frontiers in Medicine Published August 17, 2026 DOI ↗ Editorial oversight: Dr. Lars van Dijk, PhD · Surgical, Procedural & Diagnostic

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Key Takeaway

Consider combined SRT and ADT to improve b-PFS (HR 0.51) and MFS (HR 0.71) in patients with biochemical recurrence.

This systematic review and meta-analysis evaluates the efficacy of salvage radiotherapy (SRT) combined with androgen deprivation therapy (ADT) compared to SRT alone for men with biochemical recurrence following radical prostatectomy. The analysis focuses on primary outcomes including biochemical progression-free survival (b-PFS) and secondary outcomes such as metastasis-free survival (MFS), clinical progression-free survival (c-PFS), and overall survival (OS).

The meta-analysis indicates that the combination of SRT plus ADT is associated with improved b-PFS (HR 0.51; 95% CI 0.45-0.57; I^2=0%). Additionally, patients receiving combined therapy showed improved MFS (HR 0.71; 95% CI 0.60-0.84; I^2=39%). Results for clinical progression-free survival and overall survival did not show consistent benefits or were limited by heterogeneity.

Authors note that while the combination therapy improves biochemical disease control and may reduce metastasis risk, the impact on overall survival remains uncertain due to data limitations. Clinical practice relevance is focused on these patients with biochemical recurrence after radical prostatectomy. Safety considerations include endocrine and sexual side effects related to hormonal blockade, such as gynecomastia and erectile dysfunction.

How this fits prior evidence

This finding addresses a gap in managing men with biochemical recurrence after radical prostatectomy by providing evidence for combination therapy. While previous coverage noted that frailty is associated with an HR of 1.98 for lower overall survival in patients with prostate cancer, this meta-analysis specifically quantifies the benefit of SRT plus ADT on b-PFS (HR 0.51) and MFS (HR 0.71). The results clarify that while local and biochemical control are improved by adding ADT to radiotherapy, the impact on overall survival remains uncertain.

This review looked at how combining salvage radiotherapy (SRT) with androgen deprivation therapy (ADT) affects men who have biochemical recurrence after a radical prostatectomy. The study compared this combined approach against using radiation alone to see if it improved patient outcomes.

The results showed that the combination of SRT and ADT was associated with better biochemical progression-free survival. It also showed an improvement in metastasis-free survival, which means it may help reduce the risk of cancer spreading. However, the data did not show a consistent benefit for overall survival or clinical progression-free survival.

Patients receiving these treatments may experience side effects related to hormone blocking, such as endocrine and sexual issues like gynecomastia and erectile dysfunction. Because some results were limited by differences in the studies included, it is important to talk with a doctor. This treatment combination may help manage disease control for specific patients, but its impact on overall survival remains uncertain.

What this means for you:

Combining radiation and hormone therapy may improve disease control and reduce metastasis risk in some prostate cancer cases.

Common questions

What are the benefits of combining radiotherapy with androgen deprivation?

Combining salvage radiotherapy (SRT) with androgen deprivation therapy (ADT) was associated with improved biochemical progression-free survival and metastasis-free survival. This means it may help control the disease better and reduce the risk of cancer spreading in men who have had a radical prostatectomy.

Are there any side effects to this combined treatment?

Patients receiving these treatments may experience endocrine and sexual side effects. These are related to hormonal blockade and can include issues such as gynecomastia and erectile dysfunction. You should discuss these potential risks with your medical team.

Does this combination improve overall survival?

The data did not show a consistent benefit for overall survival when comparing the combined treatment to radiation alone. Because of differences in the studies, the impact on total survival remains uncertain and is not clearly proven by this analysis.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedAug 2026

View Original Abstract ↓

IntroductionSalvage radiotherapy (SRT) is one of the treatment options after progression following surgical management, with effectiveness varying according to patient risk and clinical-pathological characteristics.ObjectiveTo compare the effectiveness of SRT alone versus SRT combined with androgen deprivation therapy (ADT) in men with biochemical recurrence.MethodsWe conducted a systematic review with advanced searches in MEDLINE (PubMed), EMBASE, SCOPUS, Cochrane CENTRAL, and LILACS for the period 1990–2024. Two independent reviewers performed study selection (titles/abstracts and full text) and data extraction. Risk of bias was assessed with ROBINS-I and RoB 2.0. A random-effects meta-analysis was used to pool effect estimates. PROSPERO registration: CRD42025640604.ResultsThirteen studies were included. Nine reported overall survival (OS) and biochemical progression-free survival (b-PFS) respectively, four clinical progression-free survival (c-PFS), and eight metastasis-free survival (MFS). Combined SRT+ADT was associated with improved b-PFS (HR 0.51; 95% CI 0.45-0.57; I²=0%) and MFS (HR 0.71; 95% CI 0.60-0.84; I²=39%), whereas the remaining meta-analyzed outcomes showed no consistent benefit or were limited by heterogeneity. Regarding toxicity, the most frequent adverse events were endocrine and sexual, related to hormonal blockade, gynecomastia and erectile dysfunction.ConclusionsCombined SRT + ADT improves biochemical disease control and may reduce the risk of metastasis in selected patients with biochemical recurrence after radical postatectomy, whereas the effect on overall survival remains uncertain. Individualized management requires risk stratification when deciding on the addition and duration of ADT to optimize oncologic outcomes.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/view/, identifier CRD42025640604.

Salvage radiotherapy combined with androgen deprivation therapy improves biochemical progression-free survival in prostate cancerCombined Therapy Shows Better Outcomes for Prostate Cancer Patients

How this fits prior evidence

Common questions

Study Details

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Salvage radiotherapy combined with androgen deprivation therapy improves biochemical progression-free survival in prostate cancerCombined Therapy Shows Better Outcomes for Prostate Cancer Patients

How this fits prior evidence

Common questions

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Study Details

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