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Clinical Research

The survival impact of neoadjuvant hormonal therapy before radical prostatectomy for treatment of high-risk prostate cancer

Abstract

Background:

Several randomized controlled trials assessed the outcomes of patients treated with neoadjuvant hormonal therapy (NHT) before radical prostatectomy (RP). The majority of them included mainly low and intermediate risk prostate cancer (PCa) without specifically assessing PCa-related death (PCRD). Thus, there is a lack of knowledge regarding a possible effect of NHT on PCRD in the high-risk PCa population. We aimed to analyze the effect of NHT on PCRD in a multicenter high-risk PCa population treated with RP, using a propensity-score adjustment.

Methods:

This is a retrospective multi-institutional study including patients with high-risk PCa defined as: clinical stage T3–4, PSA >20 ng ml−1 or biopsy Gleason score 8–10. We compared PCRD between RP and NHT+RP using competing risks analysis. Correction for group differences was performed by propensity-score adjustment.

Results:

After application of the inclusion/exclusion criteria, 1573 patients remained for analysis; 1170 patients received RP and 403 NHT+RP. Median follow-up was 56 months (interquartile range 29–88). Eighty-six patients died of PCa and 106 of other causes. NHT decreased the risk of PCRD (hazard ratio (HR) 0.5; 95% confidence interval (CI) 0.32–0.80; P=0.0014). An interaction effect between NHT and radiotherapy (RT) was observed (HR 0.3; 95% CI 0.21–0.43; P<0.0008). More specifically, of patients who received adjuvant RT, those who underwent NHT+RP had decreased PCRD rates (2.3% at 5 year) compared to RP (7.5% at 5 year). The retrospective design and lack of specific information about NHT are possible limitations.

Conclusions:

In this propensity-score adjusted analysis from a large high-risk PCa population, NHT before surgery significantly decreased PCRD. This effect appeared to be mainly driven by the early addition of RT post-surgery. The specific sequence of NHT+RP and adjuvant RT merits further study in the high-risk PCa population.

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Acknowledgements

Funding for the costs of the statistical analyses was from the Leuven Cancer Institute, J. De Wever Fonds and Federico Foundation.

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Correspondence to S Joniau.

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Competing interests

LT: research grants from Bayer, Ipsen, Ferring, Janssen; consulting or advisory role for Ipsen; travel, accommodation, expenses from Astellas, Bayer and Pierre-Fabre. SJ: company consultant for Astellas, Ipsen, Bayer, Sanofi and Janssen; has received company speaker honoraria from Astellas, Amgen, Bayer, Sanofi, Janssen and Ipsen; has participated in trials for Astellas, Janssen and Bayer; has received fellowship and travel grants from Astellas, Amgen, Bayer, Sanofi, Janssen, Ipsen and Pfizer; and has received grant and research support from Astellas, Bayer and Janssen. MA: travel, accommodation, expenses from Astellas, Amgen and Bayer. WE: travel, accommodation, expenses from Astellas. RJK: research funding from GenomeDX; patents, royalties, other intellectual property from GenomeDX. PG: honoraria from Janssen, Ipsen; Speaker’s Bureau from Medacs; research funding from Astellas; travel, accommodation, expenses from Janssen. TVdB: travel, accommodation, expenses from Ipsen. FKC: consulting or advisory role from Astellas, UroTech. HVDP: honoraria from Intuitive Surgical; consulting or advisory role from Astellas; research funding from Astellas, Storz; travel, accommodation, expenses from Intuitive Surgical, Storz. BT: honoraria from Amgen, Astellas, Bayer, Ferring, Sanofi and Janssen; consulting or advisory role—Astellas, Bayer, Ferring, Janssen, Takeda, Steba Biotech, Sanofi; Speaker’s Bureau—Amgen, Janssen; research funding—Ferring; travel, accommodation, expenses—Amgen, Astellas, Bayer, Ferring Janssen, Sanofi. GM: Speaker’s Bureau from Ipsen, Takeda; travel, accommodation, expenses from Ipsen, Takeda and Ferring. GDM: honoraria from Astellas, Ipsen, AstraZeneca, Bayer, Ferring, Sanofi, Janssen; consulting or advisory role—Astellas, Bayer, Ferring, Janssen, Ipsen, Sanofi; research funding—Ipsen; travel, accommodation, expenses—all of the above. AB: honoraria from Astellas, Ipsen, Ferring; consulting or advisor role from Janssen; Speaker’s Bureau from Ipsen, Ferring and Janssen; travel, accommodation, expenses from Ipsen. Remaining authors declare no conflict of interest.

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Tosco, L., Laenen, A., Briganti, A. et al. The survival impact of neoadjuvant hormonal therapy before radical prostatectomy for treatment of high-risk prostate cancer. Prostate Cancer Prostatic Dis 20, 407–412 (2017). https://doi.org/10.1038/pcan.2017.29

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