NEW YORK (Reuters Health) Sep 12 - After radical prostatectomy for cancer involving the seminal vesicle, men fare best with adjuvant radiotherapy plus androgen deprivation therapy, a French study shows.
Seminal vesicle invasion is associated with decreased survival, and radical prostatectomy alone is "probably insufficient" in this setting, note Dr. Cyrille Bastide, at Hopital Nord in Marseille, and colleagues in their report.
Working with radical prostatectomy records on 4,090 patients from nine hospitals, they identified 310 with seminal vesicle involvement. After excluding men with lymph node metastases, detectable prostate specific antigen (PSA) after surgery, or less than 18 months' follow-up, the research team had a study group of 199 patients.
Eighty-two men were monitored without further treatment, 41 received adjuvant radiotherapy alone, 26 received only androgen deprivation therapy (ADT), and 50 received ADT combined with radiotherapy.
The estimated five-year survival rate free from biochemical failure was 32.6% in the monitored group, 44.4% in the radiotherapy-only group, 48.4% in the ADT-only group, and 82.8% with combination therapy, according to a report in BJU International online August 18th.
Estimated seven-year biochemical-failure-free survival rates in the four groups were 25.9%, 28.6%, 32.3% and 62.1%, respectively.
Only the combination of radiotherapy and androgen deprivation was an independent prognostic factor, the team found. "The hazard ratio associated with adjuvant radiotherapy combined with hormonal therapy was 0.15 (p<0.001) for biochemical progression," they calculated.
Dr. Bastide and colleagues conclude, "The findings reported in the present study suggest that adjuvant ADT combined with radiotherapy after radical prostatectomy for patients with seminal vesicle invasion confers a substantial benefit."
An editorial adds, "Continued investigation is needed to identify the accurate cohort of high risk prostate cancer patients at highest risk for cancer progression and therefore most likely to benefit from a multimodal treatment approach."
SOURCE: http://bit.ly/nG4Di4
BJU Int 2011.
Seminal vesicle invasion is associated with decreased survival, and radical prostatectomy alone is "probably insufficient" in this setting, note Dr. Cyrille Bastide, at Hopital Nord in Marseille, and colleagues in their report.
Working with radical prostatectomy records on 4,090 patients from nine hospitals, they identified 310 with seminal vesicle involvement. After excluding men with lymph node metastases, detectable prostate specific antigen (PSA) after surgery, or less than 18 months' follow-up, the research team had a study group of 199 patients.
Eighty-two men were monitored without further treatment, 41 received adjuvant radiotherapy alone, 26 received only androgen deprivation therapy (ADT), and 50 received ADT combined with radiotherapy.
The estimated five-year survival rate free from biochemical failure was 32.6% in the monitored group, 44.4% in the radiotherapy-only group, 48.4% in the ADT-only group, and 82.8% with combination therapy, according to a report in BJU International online August 18th.
Estimated seven-year biochemical-failure-free survival rates in the four groups were 25.9%, 28.6%, 32.3% and 62.1%, respectively.
Only the combination of radiotherapy and androgen deprivation was an independent prognostic factor, the team found. "The hazard ratio associated with adjuvant radiotherapy combined with hormonal therapy was 0.15 (p<0.001) for biochemical progression," they calculated.
Dr. Bastide and colleagues conclude, "The findings reported in the present study suggest that adjuvant ADT combined with radiotherapy after radical prostatectomy for patients with seminal vesicle invasion confers a substantial benefit."
An editorial adds, "Continued investigation is needed to identify the accurate cohort of high risk prostate cancer patients at highest risk for cancer progression and therefore most likely to benefit from a multimodal treatment approach."
SOURCE: http://bit.ly/nG4Di4
BJU Int 2011.
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