Androgen deprivation therapy in men with node-positive prostate cancer treated with postoperative radiotherapy Journal Article

Authors: Bravi, C. A.; Tin, A.; Vertosick, E.; Mazzone, E.; Bandini, M.; Dell'Oglio, P.; Stabile, A.; Gandaglia, G.; Fossati, N.; Sjoberg, D.; Touijer, K.; Cozzarini, C.; Briganti, A.; Montorsi, F.; Eastham, J.; Vickers, A.
Article Title: Androgen deprivation therapy in men with node-positive prostate cancer treated with postoperative radiotherapy
Abstract: Background: In men with node-positive prostate cancer after radical prostatectomy there are limited data on the value of adding androgen deprivation therapy (ADT) to postoperative radiotherapy. Objective: To determine whether there is a clear oncologic benefit to ADT in the setting of node-positive prostate cancer treated with postoperative radiotherapy. Methods: We analyzed data for 372 prostate cancer patients treated at San Raffaele Hospital with postoperative radiotherapy for node-positive disease after radical prostatectomy, 272 received both ADT and radiotherapy. Eighty-six men were followed without an event for more than 10 years. Results: Patients who received postoperative radiotherapy + ADT had more aggressive disease, with higher preoperative PSA level, higher rate of ISUP grade 5, pT3b-T4 tumors and ≥3 positive nodes. At multivariable Cox regression, the comparison between men treated by postoperative radiotherapy + ADT vs. radiotherapy alone did not show a significant difference for overall (hazards ratio: 0.91; 95% confidence interval: 0.45, 1.84; P = 0.8) and cancer-specific survival (hazards ratio: 5.39; 95% confidence intervalI: 0.70, 41.39; P = 0.11). These results remained consistent in a number of sensitivity analyses, including propensity score matching. Consideration of 95% CIs suggests that a clinically significant benefit of ADT in node-positive patients receiving radiotherapy after surgery is unlikely. Conclusions: We can exclude the sort of large survival benefit that would be required to justify the risks and toxicities of ADT in men with node-positive disease receiving postoperative radiotherapy. Awaiting larger and more powered studies on this topic, men with pN+ prostate cancer treated with postoperative radiotherapy should not receive ADT outside well-controlled clinical trials. © 2019 Elsevier Inc.
Keywords: controlled study; aged; cancer surgery; major clinical study; overall survival; cancer patient; cancer radiotherapy; comparative study; postoperative care; follow up; lymph node metastasis; lymph node dissection; pelvis lymph node; preoperative evaluation; prostate specific antigen; retrospective study; cancer mortality; prostate cancer; prostatectomy; cancer specific survival; radical prostatectomy; gonadorelin agonist; orchiectomy; androgen deprivation therapy; biochemical recurrence; postoperative radiotherapy; antineoplastic hormone agonists and antagonists; surgical margin; clinical outcome; human; male; priority journal; article; all cause mortality; node-positive prostate cancer
Journal Title: Urologic Oncology: Seminars and Original Investigations
Volume: 38
Issue: 4
ISSN: 1078-1439
Publisher: Elsevier Inc.  
Date Published: 2020-04-01
Start Page: 204
End Page: 209
Language: English
DOI: 10.1016/j.urolonc.2019.09.018
PUBMED: 31653565
PROVIDER: scopus
Notes: Article -- Export Date: 1 May 2020 -- Source: Scopus
Citation Impact
MSK Authors
  1. Abdelkrim Karim Touijer
    207 Touijer
  2. Andrew J Vickers
    614 Vickers
  3. Daniel D. Sjoberg
    156 Sjoberg
  4. James Eastham
    452 Eastham
  5. Amy Lam Ling Tin
    25 Tin
  6. Carlo Andrea Bravi
    6 Bravi