Yonsei Med J.  2018 Jul;59(5):580-587. 10.3349/ymj.2018.59.5.580.

Impact of Early Salvage Androgen Deprivation Therapy in Localized Prostate Cancer after Radical Prostatectomy: A Propensity Score Matched Analysis

Affiliations
  • 1Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea. youngd74@yuhs.ac

Abstract

PURPOSE
Androgen deprivation therapy (ADT) is used as a salvage treatment for men with biochemical recurrence (BCR) of prostate cancer (PCa) following initial radical prostatectomy (RP). The optimal time at which to begin salvage ADT (sADT) remains controversial. In this retrospective study, we evaluated the efficacy of initiating sADT in patients before prostate-specific antigen (PSA) values met the clinical definition of BCR.
MATERIALS AND METHODS
We identified 484 PCa patients who received sADT for BCR after RP. Median follow-up was 82 months. Propensity score matching was performed based on preoperative PSA level, pathologic T stage, and Gleason score. Patients were assigned to two groups of 169 patients each, based on PSA levels at the time of sADT: Group A (without meeting of the definition of BCR) and Group B (after BCR). Kaplan-Meier survival analyses and Cox regression analyses were performed.
RESULTS
The median PSA level at sADT initiation was 0.12 ng/mL in group A and 0.42 ng/mL in group B. Kaplan-Meier analyses showed that group A had favorable disease progression-free survival (DPFS) and distant metastasis-free survival (DMFS), but did not have better cancer-specific survival (CSS) than group B. In subgroup analyses, group A showed better CSS rates in the non-organ confined PCa group. In Cox regression analyses, early sADT was associated significantly with DPFS and DMFS rates, however, did not correlate with CSS (p=0.107).
CONCLUSION
Early sADT after RP improved DPFS and DMFS. Furthermore, early sADT patients demonstrated better CSS in non-organ confined PCa.

Keyword

Radical prostatectomy; androgen deprivation therapy; prostate specific antigen; salvage therapy

MeSH Terms

Disease-Free Survival
Follow-Up Studies
Humans
Male
Neoplasm Grading
Passive Cutaneous Anaphylaxis
Propensity Score*
Prostate*
Prostate-Specific Antigen
Prostatectomy*
Prostatic Neoplasms*
Recurrence
Retrospective Studies
Salvage Therapy
Prostate-Specific Antigen

Figure

  • Fig. 1 Kaplan-Meier curves of DPFS in early sADT group (Group A) and delayed sADT group (Group B). sADT, salvage androgen deprivation therapy. DPFS, disease progression-free survival.

  • Fig. 2 Kaplan-Meier curves of DMFS in early sADT group (Group A) and delayed sADT group (Group B). sADT, salvage androgen deprivation therapy. DMFS, distant metastasis-free survival.

  • Fig. 3 Kaplan-Meier curves of CSS in early sADT group (Group A) and delayed sADT group (Group B). sADT, salvage androgen deprivation therapy. CSS, cancer-specific survival.

  • Fig. 4 Kaplan-Meier curves of CSS in subgroups of early sADT group (Group A) and delayed sADT group (Group B). (A) CSS in low/intermediate-risk PCa, (B) CSS in high-risk PCa, (C) CSS in Gleason score <8 PCa, (D) CSS in Gleason score ≥8 PCa, (E) CSS in organ confined PCa, and (F) CSS in non-organ confined PCa. CSS, cancer-specific survival; PCa, prostate cancer; sADT, salvage androgen deprivation therapy.


Cited by  2 articles

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Tae Jin Kim, Young Dong Yu, Dong Soo Park, Koon Ho Rha, Sung Joon Hong, Kang Su Cho, Byung Ha Chung, Kyo Chul Koo
Yonsei Med J. 2019;60(12):1129-1137.    doi: 10.3349/ymj.2019.60.12.1129.

Trends in Prostate Cancer Prevalence and Radical Prostatectomy Rate according to Age Structural Changes in South Korea between 2005 and 2015
Hyun Young Lee, Suyeon Park, Seung Whan Doo, Won Jae Yang, Yun Seob Song, Jae Heon Kim
Yonsei Med J. 2019;60(3):257-266.    doi: 10.3349/ymj.2019.60.3.257.


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