Clinical Significance of Neoadjuvant Combined Androgen Blockade for More Than Six Months in Patients with Localized Prostate Cancer Treated with Prostate Brachytherapy

Senzaki, Tomokazu; Fukumori, Tomoharu; Mori, Hideki; Kusuhara, Yoshito; Komori, Masatsugu; Kagawa, Junichiro; Fukawa, Tomoya; Yamamoto, Yoshihiko; Yamaguchi, Kunihisa; Takahashi, Masayuki; Kubo, Akiko; Kawanaka, Takashi; Furutani, Shunsuke; Ikushima, Hitoshi; Kanayama, Hiro‐omi

doi:10.1159/000439573

Cited by 5 publications

(6 citation statements)

References 22 publications

(33 reference statements)

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“…Most of patients in these studies received short term ADT in order to downsize the prostate prior to brachytherapy. ADT consistently showed improved in bPFS in patients with lower BED/D90 (26,81,98,106), unfavourable IR (multiple risk factors) and majority of HR patients (55,56,88,90,93–95)(97). …”

Section: Discussionmentioning

confidence: 94%

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American Brachytherapy Society Task Group Report: Use of androgen deprivation therapy with prostate brachytherapy—A systematic literature review

et al. 2017

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Introduction Prostate Brachytherapy (PB) has well-documented excellent long-term outcomes in all risk groups. There are significant uncertainties regarding the role of Androgen Deprivation Therapy (ADT) with brachytherapy. The purpose of this report is to review systemically the published literature and summarize present knowledge regarding the impact of ADT on Biochemical Progression Free Survival (bPFS), Cause Specific Survival (CSS) and Overall Survival (OS). Material and Methods A literature search was conducted in Medline and Embase covering the years 1996-2016. Selected were articles with >100 patients, minimum follow-up 3 years, defined risk stratification and directly examining the role and impact of ADT on bPFS, CSS and OS. The studies were grouped to reflect disease risk stratification. We also reviewed the impact of ADT on OS, cardiovascular morbidity, mortality, and ongoing brachytherapy Randomized Controlled Trials (RCTs). Results 52 selected studies (43,303 patients) were included in this review; 7 HDR (High Dose Rate), and 45 LDR (Low Dose Rate). Twenty-five studies were multi-institutional and 27 single institution, (retrospective review or prospective data collection) and two were RCTs. The studies were heterogeneous in patient population, risk categories, risk factors, follow-up time, and treatment administered, including ADT administration and duration (median 3-12 months). Seventy one percent of the studies reported a lack of benefit, while 28% show improvement in bPFS with addition of ADT to PB. The lack of benefit was seen in LR and favourable IR disease, as well as the majority of HDR studies. A bPFS benefit of up to 15% was seen with ADT use in: patients with suboptimal dosimetry, those with multiple adverse risk factors (unfavourable IR) and most HR studies. Four studies reported very small benefit to CSS (2%). None of the studies showed OS advantage, however 3 studies reported an absolute 5-20% OS detriment with ADT. Literature suggests OS detriment is more likely in older patients or those with pre-existing cardiovascular disease (CVD). Four RCTs with an adequate number of patients and well defined risk stratification are in progress. One RTC will answer the question regarding the role of ADT with PB in favourable IR patients, and the other 3 RTCs will focus on optimal duration of ADT in the unfavourable IR and favourable HR population. Conclusions Patients treated with brachytherapy have excellent long-term disease outcomes. Existing evidence shows no benefit of adding ADT to PB in LR and favourable IR patients. Unfavourable IR, HR patients and those with suboptimal dosimetry may have up to 15% improvement in bPFS with addition of 3-12 months of ADT, with uncertain impact on CSS and a potential detriment on OS. In order to minimize morbidity one should exercise caution in prescribing ADT together with PB, in particular to older men and those with existing CVD. Due to the retrospective nature of this evidence, significant selection and treatment bias, no definitive conclusions a...

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Section: Discussionmentioning

confidence: 94%

“…Others reported that high quality implants may derive less benefit from supplemental EBRT (123) or ADT (26,81,98,106,123). The impact of ADT on OS has not been studied well, as only 19 studies (36%) reported association of ADT and OS.…”

Section: Discussionmentioning

confidence: 99%

American Brachytherapy Society Task Group Report: Use of androgen deprivation therapy with prostate brachytherapy—A systematic literature review

et al. 2017

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“…Many studies show favorable short-term results following LDR-BT for localized prostate cancer, in part because LDR-BT is primarily administered for low-and intermediate-risk cases (8,10). Our previous studies have also shown excellent short-term anticancer effects of LDR-BT in cases with lowand intermediate-risk of treatment failure (15). However, there are limited reports on the long-term results of LDR-BT in patients followed-up over 10 years after treatment (16).…”

Section: Discussionmentioning

confidence: 82%

Prostate-specific Antigen Levels Following Brachytherapy Impact Late Biochemical Recurrence in Japanese Patients With Localized Prostate Cancer

Ueno

Fukumori

Kusuhara

et al. 2023

In Vivo

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Background/Aim: Evaluation of long-term outcomes is essential for the successful treatment of localized prostate cancer; however, the risk of late recurrence following brachytherapy is still not clear. This study aimed to evaluate the long-term outcomes of low-dose-rate brachytherapy (LDR-BT) for localized prostate cancer in Japanese patients and identify factors associated with late recurrence after treatment. Patients and Methods: This single-center, cohort study included patients who underwent LDR-BT at the Tokushima University Hospital in Japan between July 2004 and January 2015; 418 patients, who were followed-up at least 7 years after LDR-BT, were included in the study. Biochemical progression free survival (bPFS) was defined according to the Phoenix definition (nadir PSA+2 ng/ml) and bPFS and cancer specific survival (CSS) were calculated using Kaplan-Meier survival curves. Univariate and multivariate analyses were performed using Cox proportional hazard regression models. Results: Approximately half of the patients with PSA >0.5 ng/ml at 5 years after LDR-BT had a recurrence within the next 2 years. However, only 1.4% of the patients with a PSA ≤0.2 ng/ml at 5 years post-treatment showed tumor recurrence, including those at high risk of treatment failure according to the D'Amico classification. In multivariate analysis, PSA level at 5 years post-treatment was the only predictor of late recurrence after 7 years of treatment. Conclusion: PSA levels at 5 years post-treatment were associated with long-term recurrence of localized prostate cancer, which can help alleviate patient anxiety concerning prostate cancer recurrence if PSA levels remain low at 5 years after LDR-BT.

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“…Regarding adjuvant antiandrogen, a randomized trial found that its use improved neither PFS nor OS in men with localized PCa after RP [139]. The combination of neoadjuvant ADT and RT can lead to significant survival benefits in men with intermediate-risk PCa compared with RT alone [133,[140][141][142][143]; however, the optimal timing and duration of neoadjuvant ADT remain ill-defined. In the RTOG 9408 trial [133], the use of ADT for 4 months (starting 2 months before RT) was effective to improve disease-specific survival and OS among patients with intermediate-risk PCa.…”

Section: Androgen Deprivation Therapymentioning

confidence: 99%

“…The 4-month ADT schedule was further supported by the RTOG 9910 trial [141], which found that extending the ADT duration to 7 months before RT did not improve survival outcomes. Yet, a retrospective study conducted in Japan showed that neoadjuvant ADT lasting for ≥6 months improved biochemical recurrence-free survival in patients with intermediate-risk PCa [143]; therefore, neoadjuvant ADT for 4-6 months can be given before the initiation of RT for intermediate-risk PCa. Statement 6: 'When RT is planned for patients with highrisk PCa, neoadjuvant (for 4-6 months) and adjuvant ADT (for 2-3 years) are recommended.…”

Section: Androgen Deprivation Therapymentioning

confidence: 99%

Consensus statements on the management of clinically localized prostate cancer from the Hong Kong Urological Association and the Hong Kong Society of Uro‐Oncology

Poon

Chan

et al. 2019

BJU International

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ObjectiveTo formulate consensus statements to facilitate physician management strategies for patients with clinically localized prostate cancer (PCa) in Hong Kong by jointly convening a panel of 12 experts from the two local professional organizations representing PCa specialists, who had previously established consensus statements on the management of metastatic PCa for the locality.MethodsThrough a series of meetings, the panellists discussed their clinical experience and the published evidence regarding various areas of the management of localized PCa, then drafted consensus statements. At the final meeting, each drafted statement was voted on by every panellist based on its practicability of recommendation in the locality.ResultsA total of 76 consensus statements were ultimately accepted and established by panel voting.ConclusionDerived from the recent evidence and major overseas guidelines, along with local clinical experience and practicability, the consensus statements were aimed to serve as a practical reference for physicians in Hong Kong for the management of localized PCa.

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Clinical Significance of Neoadjuvant Combined Androgen Blockade for More Than Six Months in Patients with Localized Prostate Cancer Treated with Prostate Brachytherapy

Cited by 5 publications

References 22 publications

American Brachytherapy Society Task Group Report: Use of androgen deprivation therapy with prostate brachytherapy—A systematic literature review

American Brachytherapy Society Task Group Report: Use of androgen deprivation therapy with prostate brachytherapy—A systematic literature review

Prostate-specific Antigen Levels Following Brachytherapy Impact Late Biochemical Recurrence in Japanese Patients With Localized Prostate Cancer

Consensus statements on the management of clinically localized prostate cancer from the Hong Kong Urological Association and the Hong Kong Society of Uro‐Oncology

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