Radiotherapy plus androgen-deprivation therapy for PSA persistence in lymph node-positive prostate cancer.

The treatment for lymph node involvement (LNI) after radical prostatectomy (RP) has not been established. This study aimed to reveal the outcomes of various management strategies among patients with LNI after RP. Retrospectively, 561 patients with LNI after pelvic lymph node dissection (PLND) with RP treated between 2006 and 2019 at 33 institutions participating in the Japanese Urological Oncology Group were investigated. Metastasis-free survival (MFS) was the primary outcome. Patients were stratified by PSA persistence after RP. Cox regression models were used to analyze the relationships between clinicopathological characteristics and survival. Survival analyses were conducted using the Kaplan-Meier method and log-rank test with or without propensity score matching. Prognoses, including MFS and overall survival, were prominently inferior among patients with persistent PSA than among those without persistent PSA. In multivariate analysis, androgen-deprivation therapy (ADT) plus radiotherapy (RT) was associated with better MFS than ADT alone among patients with persistent PSA (hazard ratio = 0.37; 95% confidence interval = 0.15-0.93; P = 0.034). Similarly, MFS and overall survival were significantly better for ADT plus RT than for ADT alone among patients with persistent PSA after propensity score matching. This study indicated that PSA persistence in LNI prostate cancer increased the risk of poor prognoses, and intensive treatment featuring the addition of RT to ADT might improve survival.

Cancer science. 2022 Apr 29 [Epub ahead of print]

Masaki Shiota, Dai Takamatsu, Takahiro Kimura, Kojiro Tashiro, Yoshiyuki Matsui, Ryotaro Tomida, Ryoichi Saito, Masakazu Tsutsumi, Akira Yokomizo, Yoshiyuki Yamamoto, Kohei Edamura, Makito Miyake, Shuichi Morizane, Takayuki Yoshino, Akihiro Matsukawa, Shintaro Narita, Ryuji Matsumoto, Takashi Kasahara, Kohei Hashimoto, Hiroaki Matsumoto, Masashi Kato, Shusuke Akamatsu, Akira Joraku, Manabu Kato, Takahiro Yamaguchi, Toshihiro Saito, Tomoyuki Kaneko, Atsushi Takahashi, Takuma Kato, Shinichi Sakamoto, Hideki Enokida, Hidenori Kanno, Naoki Terada, Shigetaka Suekane, Naotaka Nishiyama, Masatoshi Eto, Hiroshi Kitamura, Japanese Urological Oncology Group

Department of Urology, Kyushu University, Fukuoka., Department of Urology, The Jikei University School of Medicine, Tokyo., Department of Urology, National Cancer Center Hospital, Tokyo., Department of Urology, Shikoku Cancer Center, Matsuyama., Department of Urology and Andrology, Kansai Medical University, Osaka., Department of Urology, Hitachi General Hospital, Hitachi., Department of Urology, Harasanshin Hospital, Fukuoka., Department of Urology Osaka International Cancer Institute, Osaka., Department of Urology, Okayama University, Okayama., Department of Urology, Nara Medical University, Kashihara., Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, Yonago., Department of Urology, University of Tsukuba, Tsukuba., Department of Urology, Kashiwa Hospital, The Jikei University, Chiba., Department of Urology, Akita University, Akita., Department of Renal and Genitourinary Surgery, Hokkaido University, Sapporo., Division of Urology, Department of Regenerative and Transplant Medicine, Niigata University, Niigata., Department of Urology, Sapporo Medical University, Sapporo., Department of Urology, Yamaguchi University, Ube., Department of Urology, Nagoya University, Nagoya., Department of Urology, Kyoto University, Kyoto., Department of Urology, Ibaraki Prefectural Central Hospital, Ibaraki Cancer Center, Kasama., Department of Nephro-Urologic Surgery and Andrology, Mie University, Tsu., Department of Urology, Kumamoto University, Kumamoto., Department of Urology, Niigata Cancer Center Hospital, Niigata., Department of Urology, Teikyo University School of Medicine, Tokyo., Department of Urology, Hakodate Goryoukaku Hospital, Hakodate., Department of Urology, Kagawa University, Kagawa., Department of Urology, Chiba University, Chiba., Department of Urology, Kagoshima University, Kagoshima., Department of Urology, Yamagata University, Yamagata., Department of Urology, Miyazaki University, Miyazaki., Department of Urology, Kurume University School of Medicine, Kurume., Department of Urology, University of Toyama, Toyama, Japan.

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