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Post prostatectomy outcomes of patients with high-risk prostate cancer treated with neoadjuvant androgen blockade

Prostate Cancer and Prostatic Diseases volume 21, pages 364–372 (2018)Cite this article

Subjects

Abstract

Background

Patients with high-risk prostate cancer have an increased likelihood of experiencing a relapse following radical prostatectomy (RP). We previously conducted three neoadjuvant androgen-deprivation therapy (ADT) trials prior to RP in unfavorable intermediate and high-risk disease.

Methods

In this analysis, we report on the post-RP outcomes of a subset of patients enrolled on these studies. We conducted a pooled analysis of patients with available follow-up data treated on three neoadjuvant trials at three institutions. All patients received intense ADT prior to RP. The primary endpoint was time to biochemical recurrence (BCR). BCR was defined as a PSA ≥ 0.2 ng/mL or treatment with radiation or androgen-deprivation therapy for a rising PSA < 0.2 ng/mL.

Results

Overall, 72 patients were included of whom the majority had a Gleason score ≥ 8 (n = 46, 63.9%). Following neoadjuvant therapy, 55.7% of patients (n = 39/70) had pT3 disease, 40% (n = 28) had seminal vesicle invasion, 12.9% (n = 9) had positive margins, and 11.4% (n = 8) had lymph node involvement. Overall, 11 (15.7%) had tumor measuring ≤ 0.5 cm, which included four patients (5.7%) with a pathologic complete response and seven (10.0%) with residual tumor measuring 0.1–0.5 cm. Compared to pretreatment clinical staging, 10 patients (14.3%) had pathologic T downstaging at RP. The median follow-up was 3.4 years. Overall, the 3-year BCR-free rate was 70% (95% CI 57%, 90%). Of the 15 patients with either residual tumor ≤ 0.5 cm or pathologic T downstaging, no patient experienced a recurrence.

Conclusion

In this exploratory pooled clinical trials analysis, we highlight that neoadjuvant therapy prior to RP in unfavorable intermediate and high-risk patients may potentially have a positive impact on recurrence rates. Larger studies with longer follow-up periods are warranted to evaluate the impact of neoadjuvant hormone therapy on pathologic and long-term outcomes.

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Acknowledgements

We acknowledge the patients and families who participated in trials included in this analysis.

Funding

This work was supported by Janssen, Medivation, Prostate Cancer Foundation, A. David Mazzone Award Program, and the Fairweather Family Fund. The funding sponsors were not involved in the design of study, data collection and analysis, and manuscript preparation.

Author information

Author notes

  1. Rana R. McKay, Bruce Montgomery, Adam S. Kibel, and Mary-Ellen Taplin contributed equally to this work.

Authors and Affiliations

  1. Department of Medicine, Division of Hematology/Oncology, University of California San Diego, San Diego, CA, USA

    Rana R. McKay

  2. Department of Medicine, Division of Oncology, University of Washington, Seattle, WA, USA

    Bruce Montgomery, Elahe A. Mostaghel & Peter S. Nelson

  3. Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA

    Wanling Xie

  4. Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA

    Zhenwei Zhang & Mary-Ellen Taplin

  5. Department of Medicine, Division of Hematology/Oncology, Beth Israel Deaconess Medical Center, Boston, MA, USA

    Glenn J. Bubley

  6. Department of Urology, University of Washington, Seattle, WA, USA

    David W. Lin

  7. Department of Surgery, Division of Urology, Dana Farber/Brigham and Women’s Cancer Center, Boston, MA, USA

    Mark A. Preston, Quoc-Dien Trinh & Adam S. Kibel

  8. Department of Urology, Beth Israel Deaconess Medical Center, Boston, MA, USA

    Peter Chang & Andrew A. Wagner

  9. Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Philip W. Kantoff

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  1. Rana R. McKay
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Corresponding author

Correspondence to Mary-Ellen Taplin.

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Conflict of interest

RRM received research funding from Bayer and Pfizer. QDT is supported by an unrestricted educational grant from the Vattikuti Urology Institute, a Clay Hamlin Young Investigator Award from the Prostate Cancer Foundation and a Genentech BioOncology Career Development Award from the Conquer Cancer Foundation of the American Society of Clinical Oncology. RBM received research support from Jansen, Medivation and ESSA. ASK receives advisory board honorarium from Janssen, Bayer, and Sanofi-Aventis. MET receives research funding and advisory board honorarium from Janssen, Medivation.

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McKay, R.R., Montgomery, B., Xie, W. et al. Post prostatectomy outcomes of patients with high-risk prostate cancer treated with neoadjuvant androgen blockade. Prostate Cancer Prostatic Dis 21, 364–372 (2018). https://doi.org/10.1038/s41391-017-0009-6

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