Table 3.

Summary of the Studies assessing sequencing of ADT.

Trial	Year	Study Type	Risk	Treatment	N	Results	Conclusion
Weller et al. [49]	2015	Retrospective (Single institution)	HR 67.8% IR 32.3%	PORT + NA-CHT × 6 months PORT + AHT × 6 months	515	No difference in bRFS, DM, or OS	Sequencing of ADT does not appear to affect bRFS or DMFS
Lee et al. [50]	2017	Retrospective NCDB	HR	RT + NAHT RT + C-AHT WPRT 63.4% PORT 36.6% ADT Duration was unknown	11,491	NAHT improved median OS by 2.5 months	NAHT sequencing improved OS vs. C-AHT in HR PCa treated with RT + ADT.
NRG/RTOG 9413 [51]	2018	Phase-III RCT	HR (Mainly) IR	WPRT + NA-CHT × 4 months PORT + NA-CHT × 4 months WPRT + AHT × 4 months PORT + AHT × 4 months	1322	PFS and BF were better with NA-CHT + WPRT vs. AHT + WPRT or NA-CHT + PORT.	NA-CHT sequence had better PFS compared to AHT when giving WPRT. In patients treated with PORT, the PFS was worse with NA-CHT than with AHT. There was SS interaction between RT volume and sequence of ADT.
Ottawa 0101 [9]	2020	Phase-III RCT	IR (94–96%) HR (3–5%)	DE-PORT + NA-CHT × 6 months DE-PORT + C-AHT × 6 months	432	bRFS favored the C-AHR arm but not SS.	Possibility of a modest improvement in bRFS or clinical relapse with C-AHT dose-escalated PRT
Spratt et al. [10]	2021	Meta-analysis	RTOG 9413 Ottawa 0101	PORT + NA-CHT × 4–6 months PORT + AHT or C-AHT × 4–6 months	1065	C-AHT/AHT sequencing improved PFS, BF, and DM	Short-term C-AHT/AHT plus PORT improved clinically significant outcomes, including DM.

NCDB = National Cancer Database, WPRT = Whole Pelvic Radiotherapy, PORT = Prostate Only Radiotherapy.