STOCKHOLM, SWEDEN (UroToday.com) - The optimal management of lymph node positive prostate cancer (PC) remains controversial. Current data support the use of adjuvant androgen deprivation therapy (ADT) following radical prostatectomy (RP) for patients with node positive disease. The benefit of adjuvant hormonal therapy among men with micrometastatic node positive disease is limited. Dr. N. M. Passoni presented his group's analysis of a large, multi-institutional, retrospective cohort. A total of 1 338 patients undergoing RP between 1988 and 2010 with N+ disease from 3 institutions were reviewed. Patients were stratified into observation (27.9%), adjuvant ADT (48.7%), or a combination of ADT and adjuvant radiotherapy (RT) (23.4%).
At a median follow-up of 72 months (range 49-128 months), 7-year cancer specific and overall survival rates were 84.7%, 88.4%, 93.8% and 82.8%, 79.4% and 90.0% for patients undergoing observation, ADT, and combination radiotherapy/ADT, respectively. Following multivariable adjustment for age, pathological Gleason score and stage at surgery, number of positive lymph nodes, and surgical margin status, combination ADT + adjuvant RT (HR 0.26) and ADT alone (0.64) were associated with a significant decreased risk of cancer specific mortality. Not unexpectedly, Gleason score 8 or greater disease, pT3b or T4 disease, positive surgical margins, and ≥ 3 positive lymph nodes were associated with increased risk of cancer specific mortality. Further, use of ADT alone increased the risk of overall mortality (HR 3.0), while combination RT and ADT did not.
In conclusion, treatment with combination adjuvant RT and ADT was associated with improved cancer-specific mortality compared to observation or ADT alone following RP for patients with lymph node positive disease. However, given the retrospective nature of this analysis, despite multivariable adjustment, the results likely reflect selection bias. Patients selected for ADT and adjuvant RT may have been healthier and/or were perceived more likely to benefit from combination therapy. Further prospective studies are needed to provide definitive answers.
Presented by N. M. Passoni at the 29th Annual European Association of Urology (EAU) Congress - April 11 - 15, 2014 - Stockholmsmässan - Stockholm, Sweden.
Urological Research Institute, University Vita-Salute San Raffaele, Dept. of Urology, Milan, Italy
Written by Jeffrey J. Tomaszewski, MD, medical writer for UroToday.com