Open Access

ARTICLE

Does neoadjuvant hormone therapy improve outcome in prostate cancer patients receiving radiotherapy after radical prostatectomy?

Howard Huaihan Pai^1,5, Brenna Eldridge², Darcy Bishop³, Abraham Alexander^1,5, Mary Lesperance⁴, Paul Blood^1,5, Jan Lim^1,5, Charles Ludgate^1,5

1 Radiation Oncology Program, British Columbia Cancer Agency – Vancouver Island Centre, British Columbia, Canada
2 Jagiellonian University, School of Medicine in English, Krakow, Poland
3 Department of Anaesthesia, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
4 Department of Mathematics and Statistics, University of Victoria, Victoria, British Columbia, Canada
5 Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
Address correspondence to Dr. Howard H. Pai, BC Cancer Agency – Vancouver Island Centre, 2410 Lee Avenue, Victoria, British Columbia V8R 6V5 Canada

Canadian Journal of Urology 2009, 16(2), 4541-4552.

Abstract

Purpose: To assess outcome and predictive factors in men with prostate cancer who receive post radical prostatectomy (RP) radiotherapy (RT) either in the adjuvant or salvage setting, with or without neoadjuvant androgen deprivation therapy (NADT).
Methods: A retrospective analysis was performed on 175 patients with clinically localized prostate cancer treated with RP who subsequently received RT (dose range 50 Gy-68 Gy). Twenty-two patients received adjuvant RT (ART), 57 received NADT + ART, 15 received salvage RT (SRT), and 81 received NADT + SRT. Outcome was assessed by biochemical disease-free survival (BDFS), prostate cancer specific survival and overall survival (OS).
Results: Although BDFS favored patients who received NADT with 5-year rates of 67%, 80%, 27% and 62% for the ART, NADT + ART, SRT, and NADT + SRT groups respectively; this was not a significant predictor on multivariable analysis. Significant independent predictive factors of improved BDFS were pre-RT PSA ≤ 0.2 ng/ml, low Gleason score and positive surgical margins. Age and Gleason score were independent predictors of OS.
Conclusions: Pre-RT PSA is an important predictor of outcome. NADT appears to benefit patients who presented with a pre-RT PSA > 0.2 ng/ml, particularly for patients receiving SRT. NADT can be considered for patients receiving RT after RP who present with a high pre-RT PSA but may not be necessary for patients without. Results of ongoing randomized studies such as RADICALS will also help clarify the role of hormone therapy in conjunction with RT.

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