NEOADJUVANT ANDROGEN ABLATION BEFORE RADICAL PROSTATECTOMY IN cT2bNxMo PROSTATE CANCER: 5-YEAR RESULTS

Soloway, Mark S.; Pareek, Kapil; Sharifi, Rooholiah; Wajsman, Zev; McLeod, David G.; Wood, David P.; Puras-Báez, Antonio

doi:10.1016/s0022-5347(05)65393-1

Cited by 304 publications

(164 citation statements)

References 12 publications

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“…A phase III study of NAD before surgery for T2b cancer patients was reported by Soloway et al 33 No benefit was seen for the use of AD in terms of BF rates; however, for margin-negative prostate cancer BF rates were higher with than without NAD. As BF was still seen in negative margin cases, it is potentially possible that prostate cancer cells migrated outside the prostate before the surgical procedure.…”

Section: Androgen Deprivation and Radiation Therapymentioning

confidence: 98%

High-dose radiation employing external beam radiotherapy and high-dose rate brachytherapy with and without neoadjuvant androgen deprivation for prostate cancer patients with intermediate- and high-risk features

Vargas

Martı́nez

Galalae

et al. 2006

Prostate Cancer Prostatic Dis

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The role of neoadjuvant androgen deprivation (NAD) in high-risk prostate cancer patients receiving high-dose radiotherapy (RT) remains unstudied. To evaluate the effect of a course of NAD, we reviewed the experiences of three institutions treating these patients with combined RT and high-dose rate brachytherapy (HDR). Of 1260 prostate cancer patients with high-risk features (pretreatment prostate-specific antigen (PSA) X10, Gleason Score (GS) X7, or T stage XT2b), 560 received no NAD (n ¼ 308) or NAD for p6 months (n ¼ 252). Median dose to the prostate from RT and HDR was 42 and 23 Gy, respectively. Average total biologic equivalent prostate dose was 4100 Gy (a/b ¼ 1.2). Median follow-up was 4.3 years. Pretreatment characteristics were similar on v 2 tables for all 560 patients treated with or without NAD including pretreatment PSA (P ¼ 0.11), GS (P ¼ 0.4), and clinical T stage (P ¼ 0.2). Outcomes worsened for patients receiving NAD (5-year distant metastasis (DM) 10 vs 5% (P ¼ 0.04); cause-specific survival (CSS), 93 vs 98% (P ¼ 0.005)).Higher 5-year DM rates and lower CSS occurred in NAD patients with a GS between 8 and 10 (n ¼ 112 (P ¼ 0.03, P ¼ 0.02)), pretreatment PSAX15 (n ¼ 136 (P ¼ 0.03, P ¼ 0.008)), and palpable disease XT2a (n ¼ 434 (P ¼ 0.04, P ¼ 0.02)). The only two significant risk factors for DM on Cox multivariate analysis were GS (P ¼ 0.003, HR 2.8) and NAD (P ¼ 0.03, HR 2.7). AD given before definitive high-dose RT did not benefit prostate cancer patients with intermediate-and high-risk features. We favor the use of concurrent/adjuvant AD over prolonged NAD for prostate cancer patients for whom AD is clinically indicated.

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Section: Androgen Deprivation and Radiation Therapymentioning

confidence: 98%

High-dose radiation employing external beam radiotherapy and high-dose rate brachytherapy with and without neoadjuvant androgen deprivation for prostate cancer patients with intermediate- and high-risk features

Vargas

Martı́nez

Galalae

et al. 2006

Prostate Cancer Prostatic Dis

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“…3 Neoadjuvant ADT before RP decreases the positive surgical margin rate but has not been confirmed to improve relapse rates or survival. 4 Among intermediate and high risk patients receiving brachytherapy, the addition of ADT might improve relapse rates, but not survival. 5 Combination EBRT with standard BT does not consistently improve biochemical relapse rates compared to BT alone.…”

mentioning

confidence: 99%

Health Related Quality of Life in Patients Treated With Multimodal Therapy for Prostate Cancer

Wu¹,

Cooperberg²,

Sadetsky³

et al. 2008

Journal of Urology

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Purpose: Patients with prostate cancer and high risk disease characteristics may benefit from multimodal therapy. However, the effects of multimodal therapy on health related quality of life have not been comprehensively described. We further characterized health related quality of life in patients treated with multimodal therapy. Materials and Methods: Patient data were obtained from the CaPSURE™ database, a national disease registry of men with prostate cancer. Included patients received active primary therapy (ie surgery or various forms of radiation) for prostate cancer with or without adjuvant or neoadjuvant therapy, and had complete clinical data, including health related quality of life assessments at baseline and through 2 years after treatment. The association between health related quality of life outcomes and different primary therapies with and without adjuvant or neoadjuvant therapy over time was analyzed using a repeated measures mixed model for each primary therapy. Results: A total of 2,204 men met the study criteria. As primary therapy 1,427 patients received radical prostatectomy, 267 received external beam radiation therapy and 510 received brachytherapy. When androgen deprivation therapy was included with radical prostatectomy, brachytherapy or external beam radiation therapy, there was a transient loss of sexual function that improved within 9 months postoperatively. When external beam radiation therapy was given with brachytherapy there was continuous worsening of urinary function and bother through 21 months. Conclusions: Multimodal therapy may lead to declines in health related quality of life especially in the domains of urinary function, urinary bother and sexual function. These effects must be considered and patients must be counseled appropriately before initiation of multimodal therapy.

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“…Thus far, however, trials testing the neoadjuvant use of androgen deprivation therapy (7,8) or early chemotherapy (9) in prostate cancer have been disappointing and have failed to show compelling clinical or survival advantages. Recently, docetaxel, either alone or in combination with estramustine, has shown an excellent biochemical response rate (significant prostate-specific antigen reductions in z50% of men; ref.…”

mentioning

confidence: 99%

Neoadjuvant Docetaxel before Radical Prostatectomy in Patients with High-Risk Localized Prostate Cancer

Febbo¹,

Richie

George³

et al. 2005

Clinical Cancer Research

169

130

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Purpose: To determine the clinical, pathologic, and molecular effects of neoadjuvant docetaxel chemotherapy in high-risk localized prostate cancer. Experimental Design: Patients with biopsy Gleason scores of 8 to 10, serum prostate-specific antigen levels >20 ng/mL, and/or clinical stageT 3 disease received weekly docetaxel (36 mg/m 2 ) for 6 months, followed by radical prostatectomy, and were monitored with weekly visits, serum prostate-specific antigen measurements, and endorectal magnetic resonance imaging (MRI). Frozen tumor specimens were collected for microarray analysis. Results:The19 patients enrolled received 82% of the planned chemotherapy.Toxicity was mild to moderate; fatigue and taste disturbance were common. Prostate-specific antigen declines of >50% were seen in 11 of 19 patients (58%; 95% confidence interval, 33-80%) and endorectal MRI showed maximum tumor volume reduction of at least 25% in 13 of 19 patients (68%; 95% confidence interval, 47-85%) and at least 50% in 4 patients (21%; 95% confidence interval, 6-46 %). Sixteen patients completed chemotherapy and had radical prostatectomy; none achieved pathologic complete response. Microarray analysis identified coordinate up-regulation of genes involved in androgen metabolism associated with docetaxel therapy. Specifically, RNA expression for genes that decrease cellular levels of bioactive androgens was coordinately increased in response to chemotherapy. Conclusions: Neoadjuvant docetaxel administered for 6 months before radical prostatectomy is feasible, well tolerated, and often results in prostate-specific antigen declines of >50% and decreased tumor volume on endorectal MRI. No pathologic complete responses were observed. Altered androgen metabolism may partially account for the noted declines in prostate-specific antigen and be a mechanism for chemotherapy resistance.

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NEOADJUVANT ANDROGEN ABLATION BEFORE RADICAL PROSTATECTOMY IN cT2bNxMo PROSTATE CANCER: 5-YEAR RESULTS

Cited by 304 publications

References 12 publications

High-dose radiation employing external beam radiotherapy and high-dose rate brachytherapy with and without neoadjuvant androgen deprivation for prostate cancer patients with intermediate- and high-risk features

High-dose radiation employing external beam radiotherapy and high-dose rate brachytherapy with and without neoadjuvant androgen deprivation for prostate cancer patients with intermediate- and high-risk features

Health Related Quality of Life in Patients Treated With Multimodal Therapy for Prostate Cancer

Neoadjuvant Docetaxel before Radical Prostatectomy in Patients with High-Risk Localized Prostate Cancer

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