Mortality in men with localized prostate cancer treated with brachytherapy with or without neoadjuvant hormone therapy

Dosoretz, A.M.; Chen, Ming‐Hui; Salenius, S.; Ross, Rudi; Dosoretz, Daniel E.; Katin, Michael J.; Mantz, C.A.; Nakfoor, Bruce M.; D’Amico, Anthony V.

doi:10.1002/cncr.24750

Cited by 21 publications

(10 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The impact of ADT on OS has not been studied well, as only 19 studies (36%) reported association of ADT and OS. Overall 16 studies found no OS benefit with ADT, however, 3 found an OS detriment with the addition of ADT to brachytherapy (39,49) and in particular in men >73y (50). …”

Section: Discussionmentioning

confidence: 97%

“…All of these changes act to increase the risk of cardiovascular events 12 – 60 months after starting ADT (24 vs. 18% P <0.001) (48) and sudden cardiac death, by adjusted HR of 1.16 (p<.004) (40). Several studies have documented a decrease in OS in patients with localized prostate cancer treated with ADT and brachytherapy (39)(49,50). Therefore, even with short duration of only 3 months ADT can negatively impacts on quality of life, and increase morbidity and mortality (48).…”

Section: Side Effects Of Androgen Deprivation Therapymentioning

confidence: 99%

“…None of the 7 studies showed an increase in CSS with ADT. Six studies assessed the impact of ADT on OS; 3 showed no impact on OS with ADT, and 3 showed a statistically significant detriment to OS with the use of ADT (39,49,50), one showed a trend to worse OS(96). The most dramatic OS detriment was reported by Bayer at al.…”

Section: All Risk Categories (Table 5)mentioning

confidence: 99%

“…Worth noting is the small number of patients in analyses at the end of the OS curves, which brings into question the validity of the magnitude in OS detriment with ADT (39). Stone at al (49) reported a 5% OS detriment at 15 years post treatment with ADT, and Dosoretz et al found an OS detriment in men >73y age (50). …”

Section: All Risk Categories (Table 5)mentioning

confidence: 99%

See 3 more Smart Citations

American Brachytherapy Society Task Group Report: Use of androgen deprivation therapy with prostate brachytherapy—A systematic literature review

et al. 2017

View full text Add to dashboard Cite

Introduction Prostate Brachytherapy (PB) has well-documented excellent long-term outcomes in all risk groups. There are significant uncertainties regarding the role of Androgen Deprivation Therapy (ADT) with brachytherapy. The purpose of this report is to review systemically the published literature and summarize present knowledge regarding the impact of ADT on Biochemical Progression Free Survival (bPFS), Cause Specific Survival (CSS) and Overall Survival (OS). Material and Methods A literature search was conducted in Medline and Embase covering the years 1996-2016. Selected were articles with >100 patients, minimum follow-up 3 years, defined risk stratification and directly examining the role and impact of ADT on bPFS, CSS and OS. The studies were grouped to reflect disease risk stratification. We also reviewed the impact of ADT on OS, cardiovascular morbidity, mortality, and ongoing brachytherapy Randomized Controlled Trials (RCTs). Results 52 selected studies (43,303 patients) were included in this review; 7 HDR (High Dose Rate), and 45 LDR (Low Dose Rate). Twenty-five studies were multi-institutional and 27 single institution, (retrospective review or prospective data collection) and two were RCTs. The studies were heterogeneous in patient population, risk categories, risk factors, follow-up time, and treatment administered, including ADT administration and duration (median 3-12 months). Seventy one percent of the studies reported a lack of benefit, while 28% show improvement in bPFS with addition of ADT to PB. The lack of benefit was seen in LR and favourable IR disease, as well as the majority of HDR studies. A bPFS benefit of up to 15% was seen with ADT use in: patients with suboptimal dosimetry, those with multiple adverse risk factors (unfavourable IR) and most HR studies. Four studies reported very small benefit to CSS (2%). None of the studies showed OS advantage, however 3 studies reported an absolute 5-20% OS detriment with ADT. Literature suggests OS detriment is more likely in older patients or those with pre-existing cardiovascular disease (CVD). Four RCTs with an adequate number of patients and well defined risk stratification are in progress. One RTC will answer the question regarding the role of ADT with PB in favourable IR patients, and the other 3 RTCs will focus on optimal duration of ADT in the unfavourable IR and favourable HR population. Conclusions Patients treated with brachytherapy have excellent long-term disease outcomes. Existing evidence shows no benefit of adding ADT to PB in LR and favourable IR patients. Unfavourable IR, HR patients and those with suboptimal dosimetry may have up to 15% improvement in bPFS with addition of 3-12 months of ADT, with uncertain impact on CSS and a potential detriment on OS. In order to minimize morbidity one should exercise caution in prescribing ADT together with PB, in particular to older men and those with existing CVD. Due to the retrospective nature of this evidence, significant selection and treatment bias, no definitive conclusions a...

show abstract

Section: Discussionmentioning

confidence: 97%

Section: Side Effects Of Androgen Deprivation Therapymentioning

confidence: 99%

Section: All Risk Categories (Table 5)mentioning

confidence: 99%

Section: All Risk Categories (Table 5)mentioning

confidence: 99%

See 2 more Smart Citations

American Brachytherapy Society Task Group Report: Use of androgen deprivation therapy with prostate brachytherapy—A systematic literature review

et al. 2017

View full text Add to dashboard Cite

show abstract

“…The adverse effects of use have been widely studied and reported. In addition to the sexual side effects of a decreased libido and impotence [6], HT has been shown to lead to insulin resistance, dyslipidemia and the development of metabolic syndrome [7][8][9].…”

mentioning

confidence: 99%