Phase II study of neoadjuvant androgen deprivation followed by external-beam radiotherapy with 9 months of androgen deprivation for intermediate- to high-risk localized prostate cancer. Academic Article uri icon

Overview

abstract

  • PURPOSE: To evaluate the toxicity and efficacy of individualized neoadjuvant androgen deprivation (AD) to maximal response followed by external beam radiotherapy (RT) with continued AD for a total of 9 months in a prospective phase II trial. PATIENTS AND METHODS: One hundred twenty-three patients received a total of 9 months of flutamide and luprolide combined with RT. RT initiation was individualized to begin after maximum response to AD as assessed by monthly digital rectal examination and prostate-specific antigen (PSA). The neoadjuvant phase was restricted to no more than 6 months. RESULTS: Median time to initiation of RT was 4.7 months. Indications to begin RT (and their rates) were undetectable PSA (28%), PSA unchanged from one month to the next (46%), PSA rising from one month to the next (10%), 6 months of AD (14%), and other (2%). Five-year outcomes were biochemical disease-free survival, (DFS) 63% +/- 7%; clinical DFS, 75% +/- 5%; cancer-specific survival, 99% +/- 1%; and overall survival, 89% +/- 3%. Patients initiating RT after 6 months of AD had significantly lower biochemical and clinical DFS. Those patients whose testosterone recovered to normal after completion of AD had a significantly superior survival rate. Of those patients potent before treatment, 65% remained so at last follow-up. CONCLUSION: The combination of 9 months of AD and RT, with initiation of RT individualized on the basis of maximum response to AD, achieves disease control rates comparable with past studies, while preserving potency in many patients. Further studies are warranted to determine the optimal combination of AD and RT in this patient population.

authors

  • Heymann, Jonas John
  • Benson, Mitchell C
  • O'Toole, Kathleen M
  • Malyszko, Bozena
  • Brody, Rachel
  • Vecchio, Darleen
  • Schiff, Peter B
  • Mansukhani, Mahesh M
  • Ennis, Ronald D

publication date

  • January 1, 2007

Research

keywords

  • Adenocarcinoma
  • Androgen Antagonists
  • Neoadjuvant Therapy
  • Prostatic Neoplasms
  • Radiotherapy

Identity

Scopus Document Identifier

  • 35548930787

Digital Object Identifier (DOI)

  • 10.1200/JCO.2005.05.0419

PubMed ID

  • 17194907

Additional Document Info

volume

  • 25

issue

  • 1