Korean J Urol.  2011 Nov;52(11):741-745.

Impact of Adjuvant Androgen-Deprivation Therapy on Disease Progression in Patients with Node-Positive Prostate Cancer

• Park S
• Kim SC
• Kim W
• Song C
• Ahn H

Abstract

PURPOSE
The survival benefits of adjuvant androgen-deprivation therapy (ADT) in prostate cancer and lymph node metastasis remain unclear. We assessed the role of ADT in disease progression after radical prostatectomy (RP).
MATERIALS AND METHODS
Of 937 patients who underwent RP, we identified 40 (4.2%) who had lymph node metastasis. A total of 18 received adjuvant ADT (ADT group) and 22 were observed (observation group). Clinical progression-free survival (PFS), cancer- specific survival (CSS), and overall survival (OS) were compared in the 2 groups. Prognostic factors for clinical progression and biochemical recurrence (BCR) were analyzed.
RESULTS
The 5-year PFS, CSS, and OS of the entire cohort were 75.0%, 85.0%, and 72.5%, respectively. In the ADT group, 6 patients (33.3%) showed clinical progression at a median 42.7 months. The 5-year PFS, CSS, and OS rates of this group were 72.2%, 83.3%, and 72.2%, respectively. In the observation group, 14 patients (63.6%) received salvage therapy owing to BCR. Nine patients (40.9%) with BCR in the observation group showed clinical progression at a median 43.4 months after RP. The 5-year PFS, CSS, and OS rates of this group were 77.2%, 86.4%, and 72.8%, respectively. In the observation group, the BCR rate was lower in patients with pT3a or less disease than in those with pT3b disease.
CONCLUSIONS
Adjuvant ADT in node-positive prostate cancer did not reduce or delay disease progression or improve survival. Because a substantial number of untreated patients with pT3a or less disease did not experience recurrence, administration of ADT should be initiated carefully. However, in patients with pT3b disease, adjuvant ADT and radiotherapy could be considered.

Keyword

Androgens; Lymph nodes; Prostatectomy

MeSH Terms

Androgens
Cohort Studies
Disease Progression
Disease-Free Survival
Humans
Lymph Nodes
Neoplasm Metastasis
Prostate
Prostatectomy
Prostatic Neoplasms
Recurrence
Salvage Therapy
Androgens

Figure

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  FIG. 1 Clinical course of the patients. LN: lymph node, ADT: androgen deprivation therapy, CP: clinical progression, BCR: biochemical recurrence.

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  FIG. 2 Kaplan-Meier curves for clinical progression in the androgen-deprivation therapy (ADT) and observation groups.

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