Design | prospective RCT (1987–1992) | prospective RCT (1986–1991) | prospective RCT (1988–1993) | prospective RCT (1995–1998) |
Included participants | 173 patients with lymph node-positive prostate cancer and no distant metastases at study entry; no prior AST | 39 patients with lymph node-positive prostate cancer and no distant metastases at study entry; no prior AST | 98 patients with lymph node-positive prostate cancer and no distant metastases at study entry; no prior AST | 88 patients with lymph node-positive prostate cancer and no distant metastases at study entry; no prior AST |
Local therapy | radiotherapy (65–70 Gy) with/without radical prostatectomy | radiotherapy (mean 64.9-65.2 Gy) | radical prostatectomy | radical prostatectomy (74 patients) or radiotherapy (14 patients; mean 65 Gy) (c) |
Lymph node assessment | mandatory (done by lymphangiogram, computed tomography, lymphadenectomy) | mandatory (done by lymphadenectomy) | mandatory (done by lymphadenectomy) | mandatory (c) (done by lymphadenectomy, computed tomography) (d) |
Intervention (early AST) | LHRH analogues (goserelin, initiated during last week of radiotherapy; 98 patients) | orchiectomy (initiated at time of local therapy; 20 patients) | LHRH analogues (goserelin)/orchiectomy (initiated at time of local therapy; 47 patients) | anti-androgen (bicalutamide 150 mg daily) (initiated at time of local therapy, 42 patients) |
Control (deferred AST) | LHRH analogues (initiated at clinical progression; 75 patients) (a) | LHRH analogues/orchiectomy (initiated at clinical progression; 19 patients) (a) | LHRH analogues/orchiectomy (initiated at clinical progression; 51 patients) (a, b) | AST at investigators discretion (initiated at clinical progression; 46 patients) (a) |
Follow-up | median 6.5 years for all patients, 9.5 year for survivors | median 9.3 years for all patients (14–19 years), 16.5 years for survivors | median 11.9 years | median 3 years |
Definition of clinical progression | local progression: reappearance of palpable tumor after initial clearance, progression of palpable tumor (at any time), or biopsy-proven presence of carcinoma of the prostate 2 years or more after study entry. regional progression: clinical or radiographic evidence of tumor in the pelvis with or without palpable tumor in the prostate by digital examination (a) | occurrence of clinical evident local tumor growth or bone or other distant metastases (a) | evidence of recorded clinical progression or death from any cause (a) | occurrence of objective progression (confirmed by bone scan, magnetic resonance imaging, ultrasonography, or computed tomography scan) or death without progression (a) |