Immediate Hormonal Therapy Compared with Observation after Radical Prostatectomy and Pelvic Lymphadenectomy in Men with Node-Positive Prostate Cancer

Abstract

Immediate antiandrogen therapy after radical prostatectomy and pelvic lymphadenectomy improves survival and reduces the risk of recurrence in patients with node-positive prostate cancer.

Limitations of Prostate Specific Antigen Doubling Time Following Biochemical Recurrence After Radical Prostatectomy: Results From the SEARCH Database

“…Evidence from prospective randomized controlled trials is growing that adjuvant treatments improve PSA control, 4,7 and retrospective studies suggest, early receipt of secondary treatment may improve outcomes. 5,15 While mortality data remain immature, the earlier use of secondary treatment is becoming more common.…”

“…Those recurring after 2003 (n=74) were excluded to minimize the possibility that recent recurrences did not have calculable PSADT due to insufficient follow-up. Finally, we excluded patients with nodal metastases (n=15) as these patients were likely to receive immediate hormonal therapy based on evidence from Messing et al 7 This resulted in a study population of 535.…”

Case study: management of lymph node-positive disease detected at radical prostatectomy

“…The use of immediate castration (goserelin ('Zoladex') or orchiectomy) in patients such as described in this case is supported by data from an Eastern Cooperative Oncology Group trial (ECOG 7887). 10 In this trial, adjuvant castration significantly improved 10-y overall survival (51 vs 28%; P ¼ 0.025). 7,10 Other luteinizing hormone-releasing hormone agonists have not been evaluated in this setting.…”

“…10 In this trial, adjuvant castration significantly improved 10-y overall survival (51 vs 28%; P ¼ 0.025). 7,10 Other luteinizing hormone-releasing hormone agonists have not been evaluated in this setting. For the individual patient, decisions on adjuvant hormonal therapy may be driven by quality of life as well as efficacy considerations.…”

“…6,7 Given the increased risk of disease progression associated with pN þ disease, adjuvant therapy and the options available should be discussed with pN þ patients.…”