Background:Radical prostatectomy (RP) has limited cancer control potential for the patient with high-risk prostate cancer (Pca).
We prospectively examined the efficacy and safety of neoadjuvant therapy with luteinizing hormone-releasing hormone (LHRH) agonist + low-dose estramustine phosphate (EMP) (LHRH+EMP) followed by RP.
Methods: High-risk Pca was defined by the D'Amico stratification system. A total of 142 patients with high-risk Pca were enrolled in this trial from September 2005 to March 2011. The LHRH+EMP therapy included administration of LHRH agonist and 280 mg day-1EMP for 6 months before RP. Pathological cancer-free (pT0) rate on the surgical specimen was the primary end point. Secondary end points were PSA-free survival and toxicity.
Results: The average patient age was 67.4 years (interquartile range (IQR) 72, 65) and the median initial PSA level was 14.80 ng ml-1(IQR 26.22, 7.13). The median Gleason score was 9 (IQR 9, 7) and 97 patients (68.3%) had clinical stage T2c or T3. All patients completed 6 months of LHRH+EMP neoadjuvant therapy with no delays in RP. Seven patients (4.9%) achieved pT0. Surgical margins were negative in 125 patients (87.0%). At a median follow-up period of 34.9 months, PSA-free survival was 84.3%. No serious adverse events were reported during the study and there were no toxicity-related deaths.
Conclusions: Six months of LHRH+EMP neoadjuvant therapy followed by RP is safe and oncological outcomes are acceptable. Although this study was a single-arm trial with a relatively short follow-up, this treatment may have a potential to improve PSA-free survival in high-risk Pca patients. Further clinical trials are warranted.
Written by:
Koie T, Ohyama C, Yamamoto H, Hatakeyama S, Yoneyama T, Hashimoto Y, Kamimura N. Are you the author?
Department of Urology, Hirosaki University, Graduate School of Medicine, Hirosaki, Japan.
Reference: Prostate Cancer Prostatic Dis. 2012 Aug 14. Epub ahead of print.
doi: 10.1038/pcan.2012.29
PubMed Abstract
PMID: 22890389
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