Radiotherapy with or without Androgen Deprivation in the Treatment of Localized Adenocarcinoma of the Prostate

Abstract

This study analyzes the results of disease relapse and survival in two series of patients treated between 1974 and 1991 with definitive irradiation, with or without early androgen deprivation, for carcinoma of the prostate localized to the pelvis. All 264 patients were irradiated to the prostate and pelvic lymph nodes with a dose of 50 to 54 Gy in 25 to 27 fractions, followed by a 16- to 20-Gy boost in 8 to 10 fractions to the prostate and periprostatic region. Ninety percent of patients received a total dose to the prostate (pelvis + boost) of 70 Gy. Ninety-nine of the 264 patients underwent early androgen deprivation. The endocrine manipulation program was initiated 0 to 9 months before the beginning of the radiotherapy course and was continued for 2 or more years or until disease progression. All patients who relapsed after radiotherapy alone received late hormonal manipulation. After a median follow-up of 100 months, no difference in the incidence of local and distant failure rate and cancer-specific mortality was detected between the two treatment groups. The local and distant failure rates were, respectively, 19% and 40% in patients who had undergone radiotherapy and early androgen deprivation and 20% and 36% in patients who received radiotherapy alone. Cancer mortality was similar, with 35% and 30% of deaths in the former and latter group, respectively. Death for intercurrent disease, however, was significantly more frequent (p = 0.03) in patients treated with radiotherapy and hormones (19%) than in those who received radiotherapy alone (8%). Actuarial analysis of both metastasis-free and disease-free survival detected no difference between the two treatment groups, with 10-year rates of 53.3% and 42.5%, respectively, in the radiation-alone group and 45.5% and 47%, respectively, in the radiation-plus-androgen deprivation group. A statistically significant difference (p = 0.03) in overall survival in favor of patients treated with radiotherapy alone was noted, with a 10-year rate of 47%, compared with 26% observed in the radiotherapy-plus-androgen deprivation group. In conclusion, results of our study confirm numerous reports based on retrospective analyses that failed to show any benefit of hormonal management adjuvant to a definitive irradiation. The disappointing finding was the significantly better overall survival in patients who underwent radiotherapy alone.

Treatment options after failure of local curative treatments in prostate cancer: a controversial issue

“…Similarly, the RTOG 85–31 study showed significantly enhanced survival with adjuvant goserelin in patients with a Gleason score of 8–10 [48]. In contrast, in a retrospective study of 264 patients given irradiation to the prostate and pelvic lymph nodes (99 of whom underwent early androgen deprivation initiated 0–9 months before the start of radiotherapy and continued for 2 years or until disease progression) no difference between the treatment groups was detected in terms of either metastases‐free or disease‐free survival [49]. Indeed, there was a statistically significant difference in overall survival in favour of patients treated with radiotherapy alone.…”

Adjuvant and Neoadjuvant Hormonal Therapy for Prostate Cancer

“…Many early studies failed to identify any benefit [56]. However, several other groups including the RTOG and the Mayo Clinic reported positive results with respect to local control [54, 57].…”

Management of Hormone-Sensitive and Hormone-Refractory Metastatic Prostate Cancer

“…Most of these reports recognized this problem by the time of publication, and some documented an increase in noncancer mortality with this type of hormonal therapy. 18 Treatment with hormonal therapy often varied with respect to timing of onset and duration of therapy, such that they were not used in a true adjuvant setting.…”