Abstract
BackgroundThe optimal timing of salvage androgen deprivation therapy (ADT) following definitive radiation therapy for prostate cancer (PCa) is unknown. This study evaluated the efficacy of early initiation of salvage-ADT (S-ADT) based on predetermined timing among patients with unfavorable PCa treated with high-dose intensity-modulated radiation therapy (IMRT).Materials and methodsHigh-risk (HR) and very-high-risk (VHR) PCa patients treated with IMRT at our institution between September 2000 and December 2010 were analyzed retrospectively. Treatment consisted of high-dose IMRT (78 Gy/39 fractions) combined with 6 months of neoadjuvant-ADT (NA-ADT). S-ADT was initiated when prostate-specific antigen levels exceeded 4.0 ng/mL.ResultsIn total, 268 (184 HR and 84 VHR) patients were analyzed. The median follow-up period was 114.4 months. The 10-year overall survival (OS), PCa-specific survival (PCSS), biochemical failure (BF), and clinical failure (CF) rates were 82.8%, 97.1%, 27.3%, and 12.8% among the HR PCa patients and 79.4%, 87.9%, 56.2%, and 26.7% among the VHR PCa patients (p = 0.839, = 0.0377, < 0.001, and < 0.001), respectively. The 10-year cumulative incidence rates of urinary and rectal (grades 2–3) toxicities were 22.6% and 5.8%, respectively. No grade 4 or higher toxicities were observed.ConclusionHigh-dose IMRT combined with short-term NA-ADT resulted in long-term disease-free status, with acceptable morbidity among approximately three-fourths of the HR PCa patients and nearly half of the VHR PCa patients. Moreover, excellent survival outcomes were achieved by the early S-ADT initiation. This approach may be a promising alternative to uniform provision of long-term ADT.
Highlights
External beam radiotherapy (EBRT) is a major treatment modality for nonmetastatic prostate cancer (PCa)
We reported the clinical significance of early S-androgen deprivation therapy (ADT) induction based on the predetermined timing for unfavorable PCa treated with 6 months of neoadjuvantADT (NA-ADT) and high-dose intensity-modulated radiation therapy (IMRT)
We retrospectively evaluated the clinical significance of early S-ADT induction based on predetermined timing among patients with unfavorable PCa treated with highdose IMRT
Summary
External beam radiotherapy (EBRT) is a major treatment modality for nonmetastatic prostate cancer (PCa). The standard approach for unfavorable PCa is high-dose EBRT combined with long-term androgen deprivation therapy (ADT) for 2–3 years [1]. The optimal duration of ADT combined with high-dose EBRT remains unclear,. The optimal timing of salvage androgen deprivation therapy (ADT) following definitive radiation therapy for prostate cancer (PCa) is unknown. This study evaluated the efficacy of early initiation of salvage-ADT (S-ADT) based on predetermined timing among patients with unfavorable PCa treated with high-dose intensity-modulated radiation therapy (IMRT). Conclusion High-dose IMRT combined with short-term NA-ADT resulted in long-term disease-free status, with acceptable morbidity among approximately three-fourths of the HR PCa patients and nearly half of the VHR PCa patients. Excellent survival outcomes were achieved by the early S-ADT initiation This approach may be a promising alternative to uniform provision of long-term ADT
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