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High-dose radiation employing external beam radiotherapy and high-dose rate brachytherapy with and without neoadjuvant androgen deprivation for prostate cancer patients with intermediate- and high-risk features

Prostate Cancer and Prostatic Diseases volume 9, pages 245–253 (2006)Cite this article

Abstract

The role of neoadjuvant androgen deprivation (NAD) in high-risk prostate cancer patients receiving high-dose radiotherapy (RT) remains unstudied. To evaluate the effect of a course of NAD, we reviewed the experiences of three institutions treating these patients with combined RT and high-dose rate brachytherapy (HDR). Of 1260 prostate cancer patients with high-risk features (pretreatment prostate-specific antigen (PSA) ⩽10, Gleason Score (GS) ⩽7, or T stage ⩽T2b), 560 received no NAD (n=308) or NAD for ⩾6 months (n=252). Median dose to the prostate from RT and HDR was 42 and 23 Gy, respectively. Average total biologic equivalent prostate dose was >100 Gy (α/β=1.2). Median follow-up was 4.3 years. Pretreatment characteristics were similar on χ2 tables for all 560 patients treated with or without NAD including pretreatment PSA (P=0.11), GS (P=0.4), and clinical T stage (P=0.2). Outcomes worsened for patients receiving NAD (5-year distant metastasis (DM) 10 vs 5% (P=0.04); cause-specific survival (CSS), 93 vs 98% (P=0.005)). Higher 5-year DM rates and lower CSS occurred in NAD patients with a GS between 8 and 10 (n=112 (P=0.03, P=0.02)), pretreatment PSA⩽15 (n=136 (P=0.03, P=0.008)), and palpable disease ⩽T2a (n=434 (P=0.04, P=0.02)). The only two significant risk factors for DM on Cox multivariate analysis were GS (P=0.003, HR 2.8) and NAD (P=0.03, HR 2.7). AD given before definitive high-dose RT did not benefit prostate cancer patients with intermediate- and high-risk features. We favor the use of concurrent/adjuvant AD over prolonged NAD for prostate cancer patients for whom AD is clinically indicated.

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Authors and Affiliations

  1. Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI, USA

    C Vargas, A Martínez & A Harsolia

  2. Kiel University Hospital, Kiel, Germany

    R Galalae

  3. Radiation Oncology, California Endocuritherapy Cancer Center, CA, USA

    J Demanes

  4. Urology, California Endocuritherapy Cancer Center, CA, USA

    L Schour

  5. Urology Municipal Hospital Kiel, Kiel, Germany

    N Nuernberg

  6. Department of Urology, William Beaumont Hospital, Royal Oak, MI, USA

    J Gonzalez

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  1. C Vargas
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Correspondence to A Martínez.

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Presented at the ASTRO Meeting in Atlanta, Georgia 2004.

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Vargas, C., Martínez, A., Galalae, R. et al. High-dose radiation employing external beam radiotherapy and high-dose rate brachytherapy with and without neoadjuvant androgen deprivation for prostate cancer patients with intermediate- and high-risk features. Prostate Cancer Prostatic Dis 9, 245–253 (2006). https://doi.org/10.1038/sj.pcan.4500882

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