In men with node-positive prostate cancer after radical prostatectomy there are limited data on the value of adding androgen deprivation therapy (ADT) to postoperative radiotherapy.
To determine whether there is a clear oncologic benefit to ADT in the setting of node-positive prostate cancer treated with postoperative radiotherapy.
We analyzed data for 372 prostate cancer patients treated at San Raffaele Hospital with postoperative radiotherapy for node-positive disease after radical prostatectomy, 272 received both ADT and radiotherapy. Eighty-six men were followed without an event for more than 10 years.
Patients who received postoperative radiotherapy + ADT had more aggressive disease, with higher preoperative PSA level, higher rate of ISUP grade 5, pT3b-T4 tumors and ≥3 positive nodes. At multivariable Cox regression, the comparison between men treated by postoperative radiotherapy + ADT vs. radiotherapy alone did not show a significant difference for overall (hazards ratio: 0.91; 95% confidence interval: 0.45, 1.84; P = 0.8) and cancer-specific survival (hazards ratio: 5.39; 95% confidence intervalI: 0.70, 41.39; P = 0.11). These results remained consistent in a number of sensitivity analyses, including propensity score matching. Consideration of 95% CIs suggests that a clinically significant benefit of ADT in node-positive patients receiving radiotherapy after surgery is unlikely.
We can exclude the sort of large survival benefit that would be required to justify the risks and toxicities of ADT in men with node-positive disease receiving postoperative radiotherapy. Awaiting larger and more powered studies on this topic, men with pN+ prostate cancer treated with postoperative radiotherapy should not receive ADT outside well-controlled clinical trials.
Urologic oncology. 2019 Oct 22 [Epub ahead of print]
Carlo Andrea Bravi, Amy Tin, Emily Vertosick, Elio Mazzone, Marco Bandini, Paolo Dell'Oglio, Armando Stabile, Giorgio Gandaglia, Nicola Fossati, Daniel Sjoberg, Karim Touijer, Cesare Cozzarini, Alberto Briganti, Francesco Montorsi, James Eastham, Andrew Vickers
Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy; Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY. Electronic address: ., Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY., Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy., Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY., Department of Radiotherapy, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy.