The Role of Adjuvant Hormonal Treatment after Surgery for Localized High-Risk Prostate Cancer: Results of a Matched Multiinstitutional Analysis

Maria Schubert,Alberto Briganti,Burkhard Kneitz,Steven Joniau,Susanne Kneitz,Jochen Walz,Markus Graefen,Bertrand Tombal,Martin Spahn,Paolo Gontero,Paul Van Cangh,Pia Bader,R Jeffrey Karnes,D Frohneberg ,G Marchioro ,Fritz H Schröder ,Chao‐Yu Hsu ,Chris H Bangma ,Hendrik Van Poppel ,Claus‐Jürgen Scholz

doi:10.1155/2012/612707

Abstract

Introduction. To assess the role of adjuvant androgen deprivation therapy (ADT) in high-risk prostate cancer patients (PCa) after surgery. Materials and Methods. The analysis case matched 172 high-risk PCa patients with positive section margins or non-organ confined disease and negative lymph nodes to receive adjuvant ADT (group 1, n = 86) or no adjuvant ADT (group 2, n = 86). Results. Only 11.6% of the patients died, 2.3% PCa related. Estimated 5–10-year clinical progression-free survival was 96.9% (94.3%) for group 1 and 73.7% (67.0%) for group 2, respectively. Subgroup analysis identified men with T2/T3a tumors at low-risk and T3b margins positive disease at higher risk for progression. Conclusion. Patients with T2/T3a tumors are at low-risk for metastatic disease and cancer-related death and do not need adjuvant ADT. We identified men with T3b margin positive disease at highest risk for clinical progression. These patients benefit from immediate adjuvant ADT.

Highlights

To assess the role of adjuvant androgen deprivation therapy (ADT) in high-risk prostate cancer patients (PCa) after surgery
The recently reported results of the control arm of the SWOG-study S9921 showed that the combination of surgery and combined adjuvant ADT is associated with favorable disease-free and overall survival of greater than 92% at 5 years of follow-up [14]
Colette et al tried to substratify the patients from EORTCtrial 22911 and identified men with positive section margins to be at higher risk for biochemical progression [18]

Summary

Introduction

To assess the role of adjuvant androgen deprivation therapy (ADT) in high-risk prostate cancer patients (PCa) after surgery. We identified men with T3b margin positive disease at highest risk for clinical progression These patients benefit from immediate adjuvant ADT. Patients with high-risk localized prostate cancer (PCa) based on either PSA >20 ng/mL, Gleason score (GS) ≥8, or an advanced clinical stage have a risk of biochemical failure of up to 70% with surgery alone [1,2,3,4,5]. This has raised the question on the need of adjuvant treatments including androgen deprivation, radiation, and chemotherapy.

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Discussion

Conclusion