Details

Autor(en) / Beteiligte

• Cerne, J Z
• McGuire, S E
• Grant, S R
• Munsell, M F
• Lee, A K
• Kudchadker, R J
• Choi, S L
• Mahmood, U
• Hoffman, K E
• Pugh, T J
• Frank, S J
• Kuban, D A

Titel

Factors associated with improved biochemical response to neoadjuvant androgen deprivation therapy before definitive radiation therapy in prostate cancer patients

Ist Teil von

• Prostate cancer and prostatic diseases, 2013-12, Vol.16 (4), p.346-351

Ort / Verlag

London: Nature Publishing Group UK

Erscheinungsjahr

2013

Quelle

MEDLINE

Beschreibungen/Notizen

• Background: In prostate cancer patients treated with androgen deprivation therapy (ADT) and radiation therapy (RT), a pre-RT PSA level ⩾0.5 ng ml −1 , determined after neoadjuvant ADT and before RT, predicts for worse survival measures. The present study sought to identify patient, tumor and treatment characteristics associated with the pre-RT PSA in prostate cancer patients. Methods: We reviewed the charts of all patients diagnosed with intermediate- and high-risk prostate cancer and treated with a combination of neoadjuvant (median, 2.2 and 2.5 months, respectively), concurrent, and adjuvant ADT and RT between 1990 and 2011. Results: A total of 170 intermediate- and 283 high-risk patients met inclusion criteria. On multivariate analysis, both intermediate- and high-risk patients with higher pre-treatment PSA (iPSA) were significantly less likely to achieve a pre-RT PSA <0.5 ng ml −1 (iPSA 10.1–20 ng ml −1 : P =0.005 for intermediate risk; iPSA 10.1–20 ng ml −1 : P =0.005, iPSA >20 ng ml −1 : P <0.001 for high risk). High-risk patients undergoing total androgen blockade were more likely to achieve a pre-RT PSA <0.5 ng ml −1 ( P =0.031). We observed an interaction between race and type of neoadjuvant ADT ( P =0.074); whereas African-American men on total androgen blockade reached pre-RT PSA <0.5 ng ml −1 as frequently as other men on total androgen blockade ( P =0.999), African-American men on luteinizing hormone-releasing hormone (LH-RH) agonist monotherapy/orchiectomy were significantly less likely to reach pre-RT PSA <0.5 ng ml −1 compared with other men on LH-RH monotherapy/orchiectomy ( P =0.001). Conclusions: Our findings suggest that total androgen blockade in the neoadjuvant period may be beneficial compared with LH-RH monotherapy for achieving a pre-RT PSA <0.5 ng ml −1 in African-American men with high-risk prostate cancer. In addition, men with higher iPSA are more likely to have a pre-RT PSA greater than 0.5 ng ml −1 in response to neoadjuvant ADT and are therefore candidates for clinical trials testing newer, more aggressive hormone-ablative therapies.