BACKGROUND: The role of preoperative ADT for localized prostate cancer is controversial; prospective assessments have yielded varying results.
We sought to define a subset of patients with a higher likelihood of benefit from preoperative ADT.
PATIENTS AND METHODS: An institutional database including consecutive patients receiving definitive surgery for localized prostate cancer was interrogated. Patients recorded as having received preoperative ADT were matched in a 1:2 fashion to patients who had not received previous ADT. Patients were matched on the basis of clinicopathologic characteristics, use of adjuvant treatment strategies, and duration of prostate-specific antigen follow-up. Time to biochemical recurrence (TTBR) was compared using the Kaplan-Meier method and log-rank test for the overall study population and in subsets defined according to D'Amico risk.
RESULTS: No significant differences in clinicopathologic characteristics were noted between recipients (n = 101) and matched nonrecipients (n = 196) of preoperative ADT. Although not statistically significant, positive surgical margin rates, seminal vesicle invasion, and extracapsular extension were less frequent in patients receiving preoperative ADT. Furthermore, a lesser incidence of perioperative complications was noted in this group (7.4% vs. 18.4%). No significant differences were noted in TTBR between recipients and nonrecipients of preoperative ADT in the overall study population. However, among patients with high-risk disease, TTBR was significantly longer in patients who had received preoperative ADT (P = .004).
CONCLUSION: The data presented herein suggest a potential benefit of preoperative ADT in patients with high-risk localized prostate cancer. Consideration should be given to enriching for this subset in preoperative studies of novel endocrine therapies.
Written by:
Pal SK, Ruel N, Vogelzang N, Chang M, Wilson TG, Jones JO, Yuh B. Are you the author?
Department of Medical Oncology, City of Hope Comprehensive Cancer Center, Duarte, CA; Division of Biostatistics, Department of Information Science, City of Hope Comprehensive Cancer Center, Duarte, CA; US Oncology Research, Comprehensive Cancer Centers, Las Vegas, NV; Department of Medical Oncology, City of Hope Comprehensive Cancer Center, Duarte, CA; Division of Urology, Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, CA; Department of Molecular Pharmacology, City of Hope Comprehensive Cancer Center, Duarte, CA.
Reference: Clin Genitourin Cancer. 2013 Nov 12. pii: S1558-7673(13)00280-2.
doi: 10.1016/j.clgc.2013.11.009
PubMed Abstract
PMID: 24342128
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