Detrimental outcome of short term hormonal treatment and high dose radiation therapy (EBRT plus HDR) when compared to EBRT plus HDR alone for high risk prostate patients

The role of neoadjuvant androgen deprivation (NAD) in high-risk prostate cancer patients receiving high-dose radiotherapy (RT) remains unstudied. To evaluate the effect of a course of NAD, we reviewed the experiences of three institutions treating these patients with combined RT and high-dose rate brachytherapy (HDR). Of 1260 prostate cancer patients with high-risk features (pretreatment prostate-specific antigen (PSA) X10, Gleason Score (GS) X7, or T stage XT2b), 560 received no NAD (n ¼ 308) or NAD for p6 months (n ¼ 252). Median dose to the prostate from RT and HDR was 42 and 23 Gy, respectively. Average total biologic equivalent prostate dose was 4100 Gy (a/b ¼ 1.2). Median follow-up was 4.3 years. Pretreatment characteristics were similar on v 2 tables for all 560 patients treated with or without NAD including pretreatment PSA (P ¼ 0.11), GS (P ¼ 0.4), and clinical T stage (P ¼ 0.2). Outcomes worsened for patients receiving NAD (5-year distant metastasis (DM) 10 vs 5% (P ¼ 0.04); cause-specific survival (CSS), 93 vs 98% (P ¼ 0.005)).Higher 5-year DM rates and lower CSS occurred in NAD patients with a GS between 8 and 10 (n ¼ 112 (P ¼ 0.03, P ¼ 0.02)), pretreatment PSAX15 (n ¼ 136 (P ¼ 0.03, P ¼ 0.008)), and palpable disease XT2a (n ¼ 434 (P ¼ 0.04, P ¼ 0.02)). The only two significant risk factors for DM on Cox multivariate analysis were GS (P ¼ 0.003, HR 2.8) and NAD (P ¼ 0.03, HR 2.7). AD given before definitive high-dose RT did not benefit prostate cancer patients with intermediate-and high-risk features. We favor the use of concurrent/adjuvant AD over prolonged NAD for prostate cancer patients for whom AD is clinically indicated.

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Detrimental outcome of short term hormonal treatment and high dose radiation therapy (EBRT plus HDR) when compared to EBRT plus HDR alone for high risk prostate patients

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Lack of benefit of pelvic radiation in prostate cancer patients with a high risk of positive pelvic lymph nodes treated with high-dose radiation

Lack of benefit of pelvic radiation in prostate cancer patients with a high risk of positive pelvic lymph nodes treated with high-dose radiation

High-dose radiation employing external beam radiotherapy and high-dose rate brachytherapy with and without neoadjuvant androgen deprivation for prostate cancer patients with intermediate- and high-risk features

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