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Clinical Research

Integrating chemohormonal therapy and surgery in known or suspected lymph node metastatic prostate cancer

Prostate Cancer and Prostatic Diseases volume 18, pages 276–280 (2015)Cite this article

Subjects

Abstract

Background:

Prostate cancer persisting in the primary site after systemic therapy may contribute to emergence of resistance and progression. We previously demonstrated molecular characteristics of lethal cancer in the prostatectomy specimens of patients presenting with lymph node metastasis after chemohormonal treatment. Here we report the post-treatment outcomes of these patients and assess whether a link exists between surgery and treatment-free/cancer-free survival.

Methods:

Patients with either clinically detected lymph node metastasis or primaries at high risk for nodal dissemination were treated with androgen ablation and docetaxel. Those responding with PSA concentration <1 ng ml−1 were recommended surgery 1 year from enrollment. ADT was withheld postoperatively. The rate of survival without biochemical progression 1 year after surgery was measured to screen for efficacy.

Results:

Forty patients were enrolled and 39 were evaluable. Three patients (7.7%) declined surgery. Of the remaining 36, 4 patients experienced disease progression during treatment and 4 more did not reach PSA <1. Twenty-six patients (67%) completed surgery, and 13 (33%) were also progression-free 1 year postoperatively (8 with undetectable PSA). With a median follow-up of 61 months, time to treatment failure was 27 months in the patients undergoing surgery. The most frequent patterns of first disease recurrence were biochemical (10 patients) and systemic (5).

Conclusions:

Half of the patients undergoing surgery were off treatment and progression-free 1 year following completion of all therapy. These results suggest that integration of surgery is feasible and may be superior to systemic therapy alone for selected prostate cancer patients presenting with nodal metastasis.

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Acknowledgements

This work was supported in part by the National Cancer Institute at the National Institutes of Health through MD Anderson’s Support Grant P30-CA016672.

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Authors and Affiliations

  1. Department of Genitourinary Medical Oncology, MD Anderson Cancer Center, The University of Texas, Houston, TX, USA

    A J Zurita, P Dieringer, C J Logothetis & L C Pagliaro

  2. Department of Urology, MD Anderson Cancer Center, The University of Texas, Houston, TX, USA

    L L Pisters, J F Ward, J W Davis & C A Pettaway

  3. Department of Biostatistics, MD Anderson Cancer Center, The University of Texas, Houston, TX, USA

    X Wang

  4. Department of Pathology, MD Anderson Cancer Center, The University of Texas, Houston, TX, USA

    P Troncoso

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  1. A J Zurita
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  2. L L Pisters
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Correspondence to A J Zurita.

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Supplementary Information accompanies the paper on the Prostate Cancer and Prostatic Diseases website

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Zurita, A., Pisters, L., Wang, X. et al. Integrating chemohormonal therapy and surgery in known or suspected lymph node metastatic prostate cancer. Prostate Cancer Prostatic Dis 18, 276–280 (2015). https://doi.org/10.1038/pcan.2015.23

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