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Prostate Cancer Prostatic Dis. 2018 Sep;21(3):364-372. doi: 10.1038/s41391-017-0009-6. Epub 2017 Dec 20.

Post prostatectomy outcomes of patients with high-risk prostate cancer treated with neoadjuvant androgen blockade.

Author information

1
Department of Medicine, Division of Hematology/Oncology, University of California San Diego, San Diego, CA, USA.
2
Department of Medicine, Division of Oncology, University of Washington, Seattle, WA, USA.
3
Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA.
4
Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
5
Department of Medicine, Division of Hematology/Oncology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
6
Department of Urology, University of Washington, Seattle, WA, USA.
7
Department of Surgery, Division of Urology, Dana Farber/Brigham and Women's Cancer Center, Boston, MA, USA.
8
Department of Urology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
9
Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
10
Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA. Mary_Taplin@DFCI.harvard.edu.

Abstract

BACKGROUND:

Patients with high-risk prostate cancer have an increased likelihood of experiencing a relapse following radical prostatectomy (RP). We previously conducted three neoadjuvant androgen-deprivation therapy (ADT) trials prior to RP in unfavorable intermediate and high-risk disease.

METHODS:

In this analysis, we report on the post-RP outcomes of a subset of patients enrolled on these studies. We conducted a pooled analysis of patients with available follow-up data treated on three neoadjuvant trials at three institutions. All patients received intense ADT prior to RP. The primary endpoint was time to biochemical recurrence (BCR). BCR was defined as a PSA ≥ 0.2 ng/mL or treatment with radiation or androgen-deprivation therapy for a rising PSA < 0.2 ng/mL.

RESULTS:

Overall, 72 patients were included of whom the majority had a Gleason score ≥ 8 (n = 46, 63.9%). Following neoadjuvant therapy, 55.7% of patients (n = 39/70) had pT3 disease, 40% (n = 28) had seminal vesicle invasion, 12.9% (n = 9) had positive margins, and 11.4% (n = 8) had lymph node involvement. Overall, 11 (15.7%) had tumor measuring ≤ 0.5 cm, which included four patients (5.7%) with a pathologic complete response and seven (10.0%) with residual tumor measuring 0.1-0.5 cm. Compared to pretreatment clinical staging, 10 patients (14.3%) had pathologic T downstaging at RP. The median follow-up was 3.4 years. Overall, the 3-year BCR-free rate was 70% (95% CI 57%, 90%). Of the 15 patients with either residual tumor ≤ 0.5 cm or pathologic T downstaging, no patient experienced a recurrence.

CONCLUSION:

In this exploratory pooled clinical trials analysis, we highlight that neoadjuvant therapy prior to RP in unfavorable intermediate and high-risk patients may potentially have a positive impact on recurrence rates. Larger studies with longer follow-up periods are warranted to evaluate the impact of neoadjuvant hormone therapy on pathologic and long-term outcomes.

PMID:
29263420
PMCID:
PMC6013399
[Available on 2019-09-01]
DOI:
10.1038/s41391-017-0009-6
[Indexed for MEDLINE]

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