Endocrine therapy with or without radical prostatectomy for T1b‐T3N0M0 prostate cancer

Abstract

Background : We retrospectively compared the 5-year survival rates of T1b-T3N0M0 prostate cancer patients treated either by endocrine therapy plus radical prostatectomy or endocrine therapy alone. Methods : Clinical T1b-T3N0M0 prostate cancer patients were enrolled at 104 institutions in Japan. They were assigned to study 1 ( n = 176), if they were indicated to prostatectomy, if not indicated, they were assigned to study 2 ( n = 151). The indication of prostatectomy was based on the clinical judgement of physicians and/or patients. Those assigned to study 1 underwent prostatectomy and adjuvant endocrine therapy with or without preoperative androgen deprivation. Those assigned to study 2 were treated with leuprorelin acetate with or without chlormadinone acetate. They were followed-up every 3 months until death or for 5 years and over.Results : Those assigned to study 1 were younger (mean age 67.2 vs 75.7 years), less advanced in clinical stage, and had lower prostate specific antigen levels (mean 43.8 vs 103.6 ng/mL). Death for any reason was observed less frequently in study 1 ( n = 29, 16%) than study 2 ( n = 50, 33%), and the 5-year overall survival rate was higher in study 1 (87 vs. 68%). However, prostate cancer deaths were comparatively seldom (9% in study 1 and 7% in study 2), resulting in the identical 5-year cause specific survival rate in both study groups (91%). In both study groups the overall survival was almost equal to the natural survival of age-matched men. Conclusions : Endocrine therapy offers a reasonable survival rate in T1b-T3 prostate cancer patients within a 5-year follow-up. Observation will be extended to determine 10-year outcomes.

Trends in primary androgen depletion therapy for patients with localized and locally advanced prostate cancer: Japanese perspective

“…Therefore, the interstudy survival rate was compared retrospectively. ( 27 ) Both study 1 and study 2 had a 5‐year cause‐specific survival rate of approximately 90%, and the 5‐year overall survival rate was shown to be almost at the same level as the expected survival rate in both groups. This suggests that PADT provided a similar level of therapeutic effect to that obtained from radical prostatectomy.…”

Efficacy of primary hormone therapy for localized or locally advanced prostate cancer: results of a 10‐year follow‐up

“…Since 1993, we have been conducting two multicentre prospective, randomized comparative studies to evaluate the efficacy of hormone therapy for localized or locally advanced prostate cancer, and have reported the results of the 5‐year follow‐up [8–13]. In Study 1, the efficacy of neoadjuvant and adjuvant hormone therapy was investigated in men who had had a prostatectomy.…”

GnRH agonists and the rapidly increasing use of combined androgen blockade in prostate cancer

“…Similarly, it cannot be said 'All patients ultimately progress to metastatic CRPC' ). This sentence is correct for patients first treated by castration at the metastatic stage, but it does not apply for CAB treatment at the localized stage of which cure is a possibility and progression is an exception (Labrie et al 2002, 2006a, Homma et al 2004, Akaza 2006, Ueno et al 2006). …”

“…While CAB, as mentioned above, has many advantages on quality of life (including rapid response, decrease in pain, and survival) (Crawford et al 1989, Caubet et al 1997, Denis et al 1998, Bennett et al 1999, Prostate Cancer Triallists' Collaborative Group 2000, the costs are higher than other treatment options and some data suggest the possibility of negative cardiovascular effects (Levine et al 2010) which need to be further investigated and balanced with the benefits mentioned earlier (Labrie et al 2002, 2006a, b, Egawa et al 2004, Homma et al 2004, Akaza 2006, Ueno et al 2006, Namiki et al 2008.…”