The indications, rationale, and results of neoadjuvant androgen deprivation in the treatment of prostatic cancer: Memorial Sloan-Kettering Cancer Center results Conference Paper

Authors: Fair, W. R.; Cookson, M. S.; Stroumbakis, N.; Cohen, D.; Aprikian, A. G.; Wang, Y.; Russo, P.; Soloway, S. M.; Sogani, P.; Sheinfeld, J.; Herr, H.; Dalgabni, G.; Begg, C. B.; Heston, W. D. W.; Reuter, V. E.
Title: The indications, rationale, and results of neoadjuvant androgen deprivation in the treatment of prostatic cancer: Memorial Sloan-Kettering Cancer Center results
Conference Title: 1st International Conference on Neoadjuvant Hormonal Therapy of Prostate Cancer (NHT)
Abstract: Objectives. The use of neoadjuvant chemotherapy prior to definitive surgery has been firmly established in other areas of oncology, most notably in the treatment of testis and Wilm's tumors. The use of neoadjuvant androgen deprivation therapy (ADT) in conjunction with radical prostatectomy remains a source of controversy. We have conducted phase II and phase III studies to assess the effects of 3 months of preoperative ADT (goserelin and flutamide) on the pathologic staging and postsurgery prostate-specific antigen (PSA) relapse rate. We also reviewed the data confirming the understaging of clinically localized prostatic cancer and the experimental data providing the conceptual support for ADT. Methods. We report the results of 141 patients, Stage TO-TO, in a Phase II study with concurrent, nonrandomized controls (N 72) versus a treatment arm (N = 69) of men receiving 3 months of ADT with 3.6 mg goserelin for 28 days and 750 mg flutamide daily. We also report the interim results in 114 men participating in a prospective, randomized study of ADT versus surgery alone. Results. The 69 patients who received 3 months of goserelin and flutamide followed by radical prostatectomy had a pathologic organ-confined cancer rate of 74%, versus 48% in the control group who received no ADT prior to surgery. The margin-positive rate was 10% in the ADT group versus 33% in the control group. In an interim analysis of 114 patients (59 ADT, 55 control), the organ-confined and margin-positive rates were 73% and 17% in the ADT group versus 56% and 36% in the control arm, respectively. The PSA disease-free rate at a mean follow-up of 28.6 months (range 62 to 49.5 months) was 89% in the ADT-treated patients (N = 98) and 84% in the control patients (N = 96). There was no statistical difference demonstrated between the arms with respect to biochemical failure. Conclusions. While the pathologic staging of tumors following ADT treatment was improved compared with surgical controls, to date the PSA disease-free survival rates are similar. Patients with residual extracapsular (P3) disease after ADT manifest an increased PSA failure rate compared with those with P3 tumors treated by surgery alone. This suggests that ADT may identify a subset of patients with aggressive tumors that may be candidates for additional therapeutic interventions even before PSA failure occurs.
Keywords: cancer survival; aged; middle aged; survival rate; major clinical study; clinical trial; drug efficacy; conference paper; adjuvant therapy; preoperative care; chemotherapy, adjuvant; cancer staging; neoplasm staging; prostate specific antigen; phase 2 clinical trial; gonadorelin; cancer hormone therapy; prostate cancer; prostatic neoplasms; goserelin; drug therapy, combination; prostatectomy; antigen detection; androgen antagonists; phase 3 clinical trial; preoperative treatment; flutamide; antineoplastic agents, hormonal; neoplasm circulating cells; hormone inhibition; humans; human; male; priority journal
Journal Title Urology
Volume: 49
Issue: 3 Suppl. 1
Conference Dates: 1996 Mar 29-30
Conference Location: Boston, MA
ISBN: 0090-4295
Publisher: Elsevier Science, Inc.  
Date Published: 1997-03-01
Start Page: 46
End Page: 55
Language: English
DOI: 10.1016/s0090-4295(97)00169-6
PUBMED: 9123736
PROVIDER: scopus
Notes: Conference Paper -- Export Date: 17 March 2017 -- Source: Scopus
Altmetric Score
MSK Authors
  1. Warren Heston
    97 Heston
  2. Paul Russo
    457 Russo
  3. Colin B Begg
    239 Begg
  4. Guido Dalbagni
    253 Dalbagni
  5. Joel Sheinfeld
    197 Sheinfeld
  6. Victor Reuter
    922 Reuter
  7. Pramod C Sogani
    29 Sogani
  8. Harry W Herr
    407 Herr
  9. William R Fair
    199 Fair