Is ADT alone appropriate for high risk prostate cancer patients without evidence of metastasis and limited life expectancy?

I disagree with ADT alone as an option for any patient with non-metastatic prostate cancer.

For high-risk patients, 2 randomized trials have compared ADT alone vs ADT+RT. In the MRC UK PR07 trial (Mason MD et al, JCO 2015), RT improved overall survival and disease specific survival. Notably, the disease specific survival curves for the ADT vs ADT+RT arms started separating at about 3 years, and overall survival curves started to separate at 4 years. The SPCG-7 trial (Widmark A et al, Lancet 2009) showed very similar results. These 2 randomized trials clearly show that RT provides a survival advantage *early* and can benefit patients even with less than 5 year life expectancy.

On the other hand, ADT alone has not been clearly demonstrated to...