Survival outcomes of neoadjuvant hormone therapy plus external-beam radiotherapy with relatively early initiation of salvage hormone therapy to patients with T3-4N0M0 prostate cancer.

Abstract

95 Background: Survival benefits of adding long-term adjuvant hormonal therapy (A-HT) on external beam radiation therapy (EBRT) had reported in patients with locally advanced prostate cancer. However, adverse effects of long-term hormonal therapy are also not negligible. If early initiation of salvage hormonal therapy (S-HT) to patents developed PSA failure after EBRT can realize comparable survival as to giving A-HT across the board, patients who maintain biochemical failure-free status after EBRT will receive hormonal-free benefit. We analyzed outcomes of EBRT combine with neoadjuvant hormonal therapy (NA-HT) to patients with T3-4N0M0 prostate cancer. Methods: Between April 1998 and Mar 2006, consecutive 173 Japanese patients with T3-4N0M0 adenocarcinoma of the prostate were definitively treated by 3D-CRT / IMRT. The median age was 72 years old (range 48-80). Pre-treatment PSA values ranged between 3.7 and 430 ng/ml (mean: 45.3). T-stage was distributed as follows: T3a: 122, T3b: 50 and T4: 1 case. NA-HT (3–17 months, median: 5 months) was given to all cases. Mean delivered dose was 74 Gy in 2 Gy per fraction to the prostate and seminal vesicles (range: 60-78). A-HT was not given to any patients and PSA values were monitored with one to 6 months interval after the treatment. S-HT was essentially started when PSA value exceeded 4 ng/ml. Results: Median follow-up period was 74 months (range: 8–152). So far, S-HT was initiated to 58 patients, and PSA values at the initiation of S-HT ranged 0.1 to 32.2 with a median value of 6.0 ng/ml. Biochemical relapse-free survival by the Phoenix definition and salvage hormonal therapy-free survival rates at 8 years were 60% (95% CI = 51-68) and 63% (95% CI = 56-71), respectively. Prostate cancer-specific and overall survival rates were 94% (95% CI = 89-99) and 85% (95% CI = 78-92), respectively. Conclusions: Survival rates of this cohort of patients treated by EBRT combined with NA-HT were excellent despite no A-HT was given, and more than two thirds of patients maintained hormone-free status at 8 years. This approach may be an alternative to giving long-term A-HT. No significant financial relationships to disclose.