Editor's Commentary - Impact of adjuvant androgen deprivation therapy after radical prostatectomy on the survival of patients with pathological T3b prostate cancer

BERKELEY, CA (UroToday.com) - Despite prostate cancer (CaP) stage migration resulting from PSA screening, up to 35% of patients continue to be categorized as high-risk.

In other GU malignancies, multimodal therapy has proven beneficial - such as chemotherapy, radiotherapy and surgery in testes cancer and neoadjuvant chemotherapy and surgery in bladder cancer. In CaP, androgen deprivation therapy (ADT) and radiotherapy are beneficial in intermediate- and high-risk patients. A role for neoadjuvant ADT prior to radical prostatectomy (RP) has not demonstrated a survival benefit. In the British Journal of Urology International, Dr. Sameer Siddiqui and colleagues evaluate 191 patients with pT3bN0 CaP who had adjuvant ADT following RP. Stage pT3b CaP denotes seminal vesicle invasion, and these patients are reported to benefit from adjuvant radiotherapy. However, invasion of the seminal vesicles portends metastatic disease, thus suggesting a role for adjuvant ADT. They report improved outcomes.

The 191 patients were treated between 1987 and 2002 and were identified in the Mayo Clinic Prostatectomy Registry. Neoadjuvant therapy was an exclusion criterion, as was lymph node involvement. The 191 men were matched to 591 patients who had no adjuvant ADT treatment. ADT was orchiectomy in 68 men and LHRH agonist therapy in 91 men. The control matching included pathologic Gleason score, surgical margin status, pre-RP PSA level, year of surgery and patient age at surgery. The follow-up was a median of 10 years. Biochemical progression-free survival (BPFS), local recurrence-free survival (LRFS), systemic progression-free survival (SPFS), cancer specific survival (CSS) and overall survival (OS) were compared between groups.

Patients who received ADT had improved 10-year BPFS (60% vs. 16%), LRFS (87% vs. 76%), SPFS (91% vs. 78%), and CSS (94% vs. 87%). OS was similar in both groups (75% vs. 69%). ADT was beneficial, but not statistically significant for CaP specific death. Salvage therapies were less in the ADT group; 60 men (31.4%) had salvage treatment compared with 176 matched controls. There were no clear differences favoring orchiectomy vs. LHRH agonists regarding form of ADT.

 

BJU Int. 2011 Feb;107(3):383-8
10.1111/j.1464-410X.2010.09565.x

PubMed Abstract
PMID: 21265985

UroToday.com Prostate Cancer Section

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