Abstract
ObjectivePotential of combined androgen blockade (CAB) has not been explored extensively in Chinese males with prostate cancer (PCa). Therefore, this study evaluated the 2-year prostate-specific antigen (PSA) recurrence rate and quality of life (QoL) in patients with high-risk localized and locally advanced PCa receiving adjuvant hormone therapy (HT) after radical prostatectomy (RP).MethodsThis prospective, multicenter, observational study conducted in 18 centers across China enrolled patients with high-risk factor (preoperative PSA>20 ng/mL or Gleason score >7) or locally advanced PCa. Different adjuvant HT were administered after RP according to investigator’s decision in routine clinical practice. Relationship of baseline and postoperative characteristics was assessed with recurrence rate. PSA recurrence rate and Functional Assessment of Cancer Therapy-Prostate (FACT-P) QoL scores were recorded at 12 months and 24 months. Kaplan-Meier analysis was used to construct the PSA recurrence rate during follow-up.ResultsA total of 189 patients (mean age: 66.9±6.5 years) were recruited, among which 112 (59.3%) patients showed serum PSA>20 ng/mL preoperatively. The highest postoperative pathological advancement noticed was from clinical T2 (cT2) to pathological T3 (pT3) (43.9%) stage. The majority of the patients (66.1%) received CAB as adjuvant HT, for a median duration of 20.0 months. The least recurrence (15.2%) was noticed in patients treated with CAB, followed by those treated with luteinizing hormone-releasing hormone agonist (LHRHa) (16.1%), and antiandrogen (19.0%), with non-significant difference noted among the groups. None of the baseline or postoperative characteristics was related with PSA recurrence in our study. The 24-month FACT-P QoL score of 119 patients treated for >12 months showed significant improvement above baseline compared with those treated for ≤12 months.ConclusionsAdjuvant CAB therapy after RP showed reduction trend in 2-year PSA recurrence rate in high-risk Chinese patients with localized and locally advanced PCa, compared with adjuvant anti-androgens (AA) or LHRHa therapy. Further long-term therapy (>12 months) significantly improved QoL compared to short-term HT therapy, suggesting the beneficial effect of long-term CAB therapy in improving QoL.
Highlights
According to 2012 GLOBOCAN data, an estimated 1.1 million new cases of prostate cancer (PCa) occurred globally in 2012, making it the second most diagnosed cancer in men after lung cancer [1]
According to the published literature, Asian men have the least prevalence of PCa in comparison to Western (Caucasians) and Black men, which might play a role in their management [5,6]
Postoperative T-stage escalation was the highest observed in clinical T2 (cT2), with 83 (43.9%) cases in the pathological T3 (pT3) stage, when compared to preoperative staging
Summary
According to 2012 GLOBOCAN data, an estimated 1.1 million new cases of prostate cancer (PCa) occurred globally in 2012, making it the second most diagnosed cancer in men after lung cancer [1]. The 2017 United States cancer statistics reported PCa to have the first highest incidence (161,360 new cases) and the third highest estimated deaths (26,730 deaths) in men [2]. In China, cancer data obtained through National Central Cancer Registry revealed PCa as the 7th most common cancer with increasing incidences in men, though lung cancer remains the most common cause of mortality [3]. The number of PCa cases has declined in developed countries due to early prostate-specific antigen (PSA) screening and better treatment modalities. Genes including macrophage scavenger receptor 1 (MSR1), IVS7delinsTTA and 2’-5’-oligoadenylate-dependent RNase L (RNASEL) Arg462Gln are associated with PCa severity in African-American and Europeans [7]
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