Format

Send to

Choose Destination
BJU Int. 2010 Jan;105(2):185-90. doi: 10.1111/j.1464-410X.2009.08698.x. Epub 2009 Jul 8.

Long-term follow-up of 3-month neoadjuvant hormone therapy before radical prostatectomy in a randomized trial.

Author information

1
Urology Service, Department of Surgery, and Health Outcomes Research Group, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.

Abstract

OBJECTIVE:

To report our long-term follow-up of an institutional randomized prospective trial of radical prostatectomy (RP) with or without a 3-month course of neoadjuvant hormone therapy (NHT), which results in pathological downstaging, but generally no reduction in biochemical recurrence (BCR) on early follow-up (at 3 years).

PATIENTS AND METHODS:

From December 1992 to June 1996, 148 patients with clinically localized prostate cancer were randomized to RP only or 3 months of goserelin acetate and flutamide before RP. BCR was defined as a detectable serum prostate specific antigen level (>0.1 ng/mL) at least 6 weeks after surgery, with a confirmatory increase.

RESULTS:

The median follow-up for BCR-free patients was 8 years. There was no significant difference in BCR-free probabilities between groups (P = 0.7). The BCR-free probability at 7 years was 78% for patients undergoing RP only and 80% for patients undergoing NHT and RP (difference of 2%; 95% confidence interval, CI, 12-16%). A Cox regression showed no significant relationship between NHT and BCR (hazard ratio 1.16; 95% CI, 0.56-2.39, P = 0.7). Overall, two patients had local recurrence and six developed metastases, and were evenly distributed among the RP only and NHT groups.

CONCLUSION:

Although our study was not originally powered to detect differences in BCR, there was no overall benefit in BCR-free probability, local recurrence or metastasis with 3 months of NHT at 8 years of follow-up. Pending evidence of improvement in patient outcomes, NHT before RP appears to be unjustified outside of clinical trials.

PMID:
19594741
PMCID:
PMC2807908
DOI:
10.1111/j.1464-410X.2009.08698.x
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Wiley Icon for PubMed Central
Loading ...
Support Center