Original Article

Clinical Research

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

  • Prostate Cancer and Prostatic Diseases volume 20, pages 407412 (2017)
  • doi:10.1038/pcan.2017.29
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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.

Author information

Affiliations

  1. Department of Development and Regeneration, University Hospitals Leuven, Urology, Leuven, Belgium

    • L Tosco
    • , M Albersen
    • , W Everaerts
    • , H Van Poppel
    •  & S Joniau
  2. Department of Imaging and Pathology, Nuclear Medicine and Molecular Imaging, KU Leuven, Leuven, Belgium

    • L Tosco
  3. Department of Public Health and Primary Care, Leuven Biostatistics and Statistical Bioinformatics Center, KU Leuven, Leuven, Belgium

    • A Laenen
  4. Department of Urology, San Raffaele Hospital, University VitaSalute, Milan, Italy

    • A Briganti
  5. Department of University Urology, Urologia U, Città della Salue e della Scienza di Torino, Molinette Hospital, Turin, Italy

    • P Gontero
    •  & A Battaglia
  6. Department of Urology, Mayo Clinic, Rochester, MN, USA

    • R J Karnes
  7. Department of Urology, Urologische Klinik Und Poliklinik, Klinikum Der Universität München Campus Großhadern, Munich, Germany

    • P J Bastian
    •  & C Gratzke
  8. Department of Urology, Jagiellonian University Medical College, Krakow, Poland

    • P Chlosta
  9. Department of Cellular and Molecular Medicine, Laboratory of Molecular Endocrinology, KU Leuven, Leuven, Belgium

    • F Claessens
    • , T Van den Broeck
    •  & L Moris
  10. Department of Urology, University of Hamburg, Hamburg, Germany

    • F K Chun
  11. Department of Urology, Martini Klinik am UKE GmbH, Hamburg, Germany

    • M Graefen
  12. Department of Urology and Pediatric Urology, University Hospital Wurzburg, Wurzburg, Germany

    • B Kneitz
  13. Department of Urology, University of Piemonte Orientale, Novara, Italy

    • G Marchioro
  14. Department of Urology, Institut Mutualiste Montsouris and Paris Descartes University, Paris, France

    • R S Salas
  15. Department of Urology, Cliniques Universitaires SaintLuc, Brussels, Belgium

    • B Tombal
  16. Department Of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands

    • H van der Poel
  17. Department of Urology, Institut Paoli Calmettes Cancer Centre, Marseille, France

    • J Walz
  18. Department of Radiation Oncology, Gustave Roussy Cancer Institute, Villejuif, France

    • A Bossi
  19. Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium

    • G De Meerleer
    •  & K Haustermans
  20. Department of Urology, University Hospital Bern, Inselspital, Berne, Switzerland

    • M Spahn

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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.

Corresponding author

Correspondence to S Joniau.