Early results of a prospective study of hormone therapy for patients with locally advanced prostate carcinoma

Fowler, Jackson E.; Bigler, Steven A.; Kolski, John M.; Yee, David T.

doi:10.1002/(sici)1097-0142(19980315)82:6<1112::aid-cncr15>3.0.co;2-9

Cited by 14 publications

(8 citation statements)

References 20 publications

(1 reference statement)

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“…The present results and those of Fowler et al 19 show the favorable impact of hormone therapy alone on tumor progression in men with locally advanced prostate carcinoma. It may suggest that radiation therapy makes little contribution to locally advanced cancer.…”

Section: Discussionsupporting

confidence: 80%

“…Disease progression among patients who received radiation plus hormone therapy was due to distant failure in 85% of cases and the 5 year disease-free survival was 85%. In contrast, Fowler et al 19 conducted a prospective study of androgen ablation in men with T3-4 prostate carcinoma. The 5 year cause-specific and metastasisfree survival rates were 84 and 84%, respectively.…”

Section: Discussionmentioning

confidence: 99%

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Prognosis of patients with T4 prostate carcinoma

et al. 1999

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Background: The clinical course of patients with T4 prostate carcinoma was examined in order to consider whether there are alternative treatment options besides androgen ablation therapy. Methods: From 1986 to 1995 at Chiba University Hospital, there were 22 cases of T4 prostate carcinoma. Sixteen cases had no bone metastasis at initial diagnosis. Tumor grade and response of prostate-specific antigen (PSA) to endocrine treatment were evaluated in these 16 cases. Results: Four patients had moderately differentiated and 12 had poorly differentiated adenocarcinoma. For initial treatment, all patients received endocrine therapy. Anti-androgen therapy was effective in 15 cases and the 5 year cause-specific and progression-free survival rates were 72.1 and 38.1%, respectively. Patients with moderately differentiated tumors tended to have a longer disease-free period than those with poorly differentiated tumors (P = 0.047). Conclusions: Endocrine therapy was effective in patients with T4 tumors. It was suggested that aggressive local treatment (i.e. radiotherapy) in combination with endocrine therapy may be considered if the patients had no distant metastases and had a long life expectancy.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Prognosis of patients with T4 prostate carcinoma

et al. 1999

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“…Most importantly, the observation period (2 years) was too short to enable us to draw any conclusions on the long‐term effects of the different treatment arms. Because monotherapy with medical or surgical castration is fairly efficacious for advanced prostate cancer, 26 additional effects that may have been achieved by preoperative endocrine therapy could not be detected unless an even longer observation period was used. Also, we have acknowledged the importance of a longer follow‐up period and prompted the participating investigators to collaborate on a further follow up of the patients if possible.…”

Section: Discussionmentioning

confidence: 99%

Early results of radical prostatectomy and adjuvant endocrine therapy for prostate cancer with or without preoperative androgen deprivation

et al. 1999

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Background: The effects of preoperative androgen deprivation were explored in the patients who received radical prostatectomy and subsequent adjuvant endocrine therapy for prostate cancer. Methods: Stage A 2 , B or C prostate cancers were randomized to one of two groups: (i) group I (n = 90), who received androgen deprivation (leuploride and chlormadinone acetate) for 3 months preoperatively followed by radical prostatectomy and adjuvant endocrine therapy (leuploride only); and (ii) group II (n = 86), who underwent the surgery followed by 3 month androgen deprivation and subsequent adjuvant endocrine therapy. The effects of preoperative androgen deprivation on clinical relapse (serum prostate specific antigen (PSA) > 1.98 ng/mL, local recurrence or distant metastasis) and PSA relapse (PSA > 0.2 ng/mL) were evaluated at 2 years after randomization.Results: There was no significant difference in clinical or PSA relapse-free survival and quality of life measures between the two groups, although relapses occurred significantly more frequently in patients who had more advanced stages, higher pretreatment PSA values or lower histologic differentiation in either group. Subgroup analysis indicated that clinical relapse-free survival in stage C cancer tended to be better in patients with preoperative androgen deprivation than in those patients without it (P < 0.1).Conclusions: Preoperative androgen deprivation may be beneficial for stage C prostate cancer patients receiving radical prostatectomy and adjuvant endocrine therapy over the 2 year observation period. A longer follow up is needed to clarify the exact extent of benefit in terms of survival and quality of life.

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“…Clearly this is a patient population in need of multimodal therapy. There has been a renewed interest in chemotherapy and hormonal regimens [26][27][28]. Rather than chemotherapy as salvage, researchers are beginning to rethink a paradigm and look at chemotherapy up front in patients with high-risk disease rather than waiting until they fail extensively.…”

Section: Surgical Aspects Of Management (Dr Joseph Harryhill)mentioning

confidence: 99%

Progressing Prostate Carcinoma

et al. 2001

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In the Karnell Cancer Center Grand Rounds, we present a patient who underwent radical prostatectomy with bilateral pelvic lymphadenectomy, but had positive margins and subsequently developed local recurrence and then systemic disease. Pathologic and radiologic aspects of his disease are discussed. Therapeutic options at different stages of the disease are examined from the point of view of the urologist, radiation oncologist, and medical oncologist.The surgical portion of the discussion focuses on the selection of initial therapy. Both the selection of surgical candidates and choice of pre-or post-operative therapy in patients can be aided by prognostic tools looking at several variables, including prostate-specific antigen (PSA) level, Gleason score of the tumor, seminal vesicle invasion, extracapsular invasion, and lymph node involvement. Low-risk patients can be treated with monotherapy, such as radical prostatectomy, external beam radiation therapy, prostate brachytherapy, or cryosurgical ablation of the prostate. Higher risk patients may require adjuvant and possibly neoadjuvant therapy in addition.The radiation portion of the discussion focuses on the use of radiation therapy as salvage for relapsing disease.Of particular importance is the point that treating highrisk patients whose PSA levels have started to rise but are less than 1 ng/ml results in a long-term PSA control rate as high as 75%, but that limiting the use of salvage radiation therapy to patients with high PSA levels or biopsy confirmation of local recurrence in the face of a negative bone scan results in biochemical long-term control of less than 40%.In the medical oncology part of the discussion, the major focus is on the use of chemotherapy to treat patients whose disease has become resistant to hormonal therapy. Mitoxantrone plus a corticosteroid has been found to offer significant palliation for such patients. Combination therapy with estramustine plus taxanes, other microtubule inhibitors, or other agents such as topoisomerase II inhibitors, has been found to cause shrinkage of measurable soft tissue disease and diminution of serum PSA levels. The development of effective hormonal and chemotherapeutic drugs for treatment of metastatic disease has led to new interest in adjuvant and neoadjuvant therapy of high-risk patients.

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Early results of a prospective study of hormone therapy for patients with locally advanced prostate carcinoma

Cited by 14 publications

References 20 publications

Prognosis of patients with T4 prostate carcinoma

Prognosis of patients with T4 prostate carcinoma

Early results of radical prostatectomy and adjuvant endocrine therapy for prostate cancer with or without preoperative androgen deprivation

Progressing Prostate Carcinoma

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