Thanks, Pratoman.
(Your link didn't work for me.
Corrected link)
From the JAMA study linked and discussed in this news article:
"Discussion
In this secondary analysis of the RTOG 9408 randomized clincial trial,3 FIR and UIR subclassifications were associated with higher risks of DM, PCSM, and ACM. Although previous studies have shown differences in prostate cancer–specific outcomes with FIR and UIR disease,1,2,5 to our knowledge, this study is the first to demonstrate an ACM difference.
Additionally, this study suggests that patients with UIR, but not FIR, undergoing radiotherapy have improved outcomes with short-term ADT. Although previous studies have also suggested this,1,2 they have been retrospective studies limited by selection bias in usage of ADT and short follow-up. Our study, using a large multi-institutional cohort from a cooperative group trial with randomized ADT use and nearly 18 years of follow-up, overcomes these limitations. To our knowledge, these are the highest-quality data supporting recent changes in the National Comprehensive Cancer Network guidelines recommending radiation without ADT for patients with FIR disease and combined ADT and radiotherapy for patients with UIR disease. Notably, given Gleason score inflation,6 improvements in radiation delivery, and advances in imaging over the last 25 years, it is likely that ADT would have even less benefit to contemporary patients with FIR than those enrolled in RTOG 9408.
Multiple limitations of this study warrant discussion, including that it is an unplanned secondary analysis and approximately 16% of patients with intermediate-risk cancer were excluded for having insufficient biopsy core information. Additionally, Gleason score migration over the last 2 decades and changes in radiation techniques make extrapolation to contemporary patients more challenging."
[UIR = unfavorable intermediate risk; FIR = favorable intermediate risk; DM = distant metastases; PCSM = prostate cancer–specific mortality; ACM = all-cause mortality]
Note that the NCCN's
expanded definitions of FIR and UIR go beyond just the G score -- see the Prostate News article.