Androgen deprivation therapy during and after post-prostatectomy radiotherapy in patients with prostate cancer: a case control study

Myong Kim,In Gab Jeong,Choung-Soo Kim,Cheryn Song,Seung-Kwon Choi,Dalsan You,Hanjong Ahn,Young Seok Kim,Myungchan Park,Jun Hyuk Hong,Myungsun Shim

doi:10.1186/s12885-018-4189-9

Myong Kim, In Gab Jeong + Show 9 more

Open Access

https://doi.org/10.1186/s12885-018-4189-9

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Journal: BMC Cancer	Publication Date: Mar 9, 2018
Citations: 3	License type: open-access

Affiliation: University of Ulsan, Asan Medical Center, Ulsan College

Abstract

BackgroundHere we assessed the influence of androgen deprivation therapy (ADT) during and/or after post-prostatectomy radiotherapy (RT) on biochemical recurrence (BCR) and radiographic progression in patients with prostate cancer.MethodsPatients with prostate cancer who underwent post-prostatectomy RT were analyzed. BCR and radiographic progression after RT were compared according to the concurrent or salvage ADT. Cox regression analyses were used to identify risk factors for BCR and radiographic progression.ResultsOf the 227 patients who underwent post-prostatectomy RT, 95 (41.9%) received concurrent ADT for a median of 17.0 months. Despite more aggressive disease characteristics in the concurrent ADT group than in the RT-only group, the former had a better 5-year BCR-free survival rate than the latter (66.1 vs. 53.9%; p = 0.016), whereas the radiographic progression rate was not significantly different between two groups. On the other hand, salvage ADT after post-RT BCR significantly delayed radiographic progression (5-year radiographic progression-free survival; 75.2 vs. 44.5%; p = 0.002).ConclusionsConcurrent ADT improved BCR-free survival, and salvage ADT after post-RT BCR improved radiographic progression-free survival. To maximize the oncological benefit, ADT of sufficient duration should be implemented.

Highlights

We assessed the influence of androgen deprivation therapy (ADT) during and/or after postprostatectomy radiotherapy (RT) on biochemical recurrence (BCR) and radiographic progression in patients with prostate cancer
Despite the stage migration in prostate cancer noted in this prostate specific antigen (PSA) screening era, extraprostatic disease continues to occur in more than onethird of patients who undergo radical prostatectomy (RP) [1, 2]
The exclusion criteria were the presence of other malignancies (n = 4, 1.2%), ineligibility according to American Society for Radiation Oncology (ASTRO)/ American Urological Association (AUA) criteria for adjuvant or salvage RT [3] (n = 1, 0.3%), the administration of neoadjuvant ADT before RP (n = 7, 2.1%), failure to complete the planned RT dose (n = 2, 0.6%), and incomplete clinical data or loss to followup (n = 15, 4.5%)

Summary

Introduction

We assessed the influence of androgen deprivation therapy (ADT) during and/or after postprostatectomy radiotherapy (RT) on biochemical recurrence (BCR) and radiographic progression in patients with prostate cancer. RP, namely the SWOG 8794 [6], EORTC 22911 [7], and ARO 96–02 [8], demonstrated that adjuvant RT reduced the risks of biochemical recurrence (BCR) and local relapse by approximately 20% at 5 years among patients with adverse pathologic features (i.e., seminal vesicle invasion, positive surgical margins with or without extraprostatic extension). The results of some large observational studies have indicated that salvage RT effectively controls locally recurrent disease after RP [9, 10]. Patients with adverse pathologic characteristics or those who experience PSA recurrences after RP can harbor micrometastases that cannot be detected by imaging. In these cases, it may be beneficial to combine

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