The survival impact of neoadjuvant hormonal therapy before radical prostatectomy for treatment of high-risk prostate cancer.

Tosco, L; Laenen, A; Briganti, A; Gontero, P; Karnes, R J; Albersen, M; Bastian, P J; Chlosta, P; Claessens, F; Chun, F K; Everaerts, W; Gratzke, C; Graefen, M; Kneitz, B; Marchioro, G; Salas, R S; Tombal, B; Van den Broeck, T; Moris, L; Battaglia, A; ... (2017). The survival impact of neoadjuvant hormonal therapy before radical prostatectomy for treatment of high-risk prostate cancer. Prostate cancer and prostatic diseases, 20(4), pp. 407-412. Nature 10.1038/pcan.2017.29

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BACKGROUND

Several randomized controlled trials assessed the outcomes of patients treated with neoadjuvant hormonal therapy (NHT) before radical prostatectomy (RP). The majority of them included mainly low and intermediate risk prostate cancer (PCa) without specifically assessing PCa-related death (PCRD). Thus, there is a lack of knowledge regarding a possible effect of NHT on PCRD in the high-risk PCa population. We aimed to analyze the effect of NHT on PCRD in a multicenter high-risk PCa population treated with RP, using a propensity-score adjustment.

METHODS

This is a retrospective multi-institutional study including patients with high-risk PCa defined as: clinical stage T3-4, PSA >20 ng ml-1 or biopsy Gleason score 8-10. We compared PCRD between RP and NHT+RP using competing risks analysis. Correction for group differences was performed by propensity-score adjustment.

RESULTS

After application of the inclusion/exclusion criteria, 1573 patients remained for analysis; 1170 patients received RP and 403 NHT+RP. Median follow-up was 56 months (interquartile range 29-88). Eighty-six patients died of PCa and 106 of other causes. NHT decreased the risk of PCRD (hazard ratio (HR) 0.5; 95% confidence interval (CI) 0.32-0.80; P=0.0014). An interaction effect between NHT and radiotherapy (RT) was observed (HR 0.3; 95% CI 0.21-0.43; P<0.0008). More specifically, of patients who received adjuvant RT, those who underwent NHT+RP had decreased PCRD rates (2.3% at 5 year) compared to RP (7.5% at 5 year). The retrospective design and lack of specific information about NHT are possible limitations.

CONCLUSIONS

In this propensity-score adjusted analysis from a large high-risk PCa population, NHT before surgery significantly decreased PCRD. This effect appeared to be mainly driven by the early addition of RT post-surgery. The specific sequence of NHT+RP and adjuvant RT merits further study in the high-risk PCa population.

Item Type:	Journal Article (Original Article)
Division/Institute:	04 Faculty of Medicine > Department of Dermatology, Urology, Rheumatology, Nephrology, Osteoporosis (DURN) > Clinic of Urology
UniBE Contributor:	Spahn, Martin
Subjects:	600 Technology > 610 Medicine & health
ISSN:	1476-5608
Publisher:	Nature
Language:	English
Submitter:	Laetitia Hayoz
Date Deposited:	05 Mar 2018 15:33
Last Modified:	05 Dec 2022 15:09
Publisher DOI:	10.1038/pcan.2017.29
PubMed ID:	28485390
URI:	https://boris.unibe.ch/id/eprint/109167