Survival after radical prostatectomy for prostate cancer is better among men who undergo androgen deprivation therapy (ADT) and external beam radiation therapy (EBRT), according to a retrospective analysis.
"This study determines that the population of patients with node-positive disease is heterogeneous and, as such, a risk-management tool would allow the identification of a group of patients in whom the multidisciplinary approach by way of surgery, radiation, and ADT has the greatest value,” Dr. Karim A. Touijer from Memorial Sloan Kettering Cancer Center, in New York, told Reuters Health by email.
Dr. Touijer and colleagues used data from three centers in the U.S. and Europe to quantify survival differences in 1,388 men with lymph-node metastases after radical prostatectomy managed with observation, lifelong adjuvant ADT, or a combination of adjuvant ADT plus EBRT. They then used these findings to develop a model to predict all-cause mortality.
All-cause mortality risk was significantly lower in men treated with ADT plus EBRT than in men who received only observation (hazard ratio, 0.41) or ADT alone (HR, 0.46), the researchers report in European Urology, online October 14.
Prostate cancer-specific death rates were 36% lower among men treated with adjuvant ADT than among men managed with observation alone.
The Cox model for predicting all-cause mortality within 10 years included postoperative Gleason score, pathology T stage, surgical margin status, and the number of positive nodes. The coefficient estimates from the Cox model were multiplied by 4 and rounded to the nearest integer value to determine the points associated with each predictor, for a total score ranging from 0 to 8.
According to this model, the difference in the predicted risk of 10-year all-cause mortality between men treated with ADT and EBRT versus those treated without the combination increased from 4.8 percentage points with a score of zero to 39.8 percentage points with a score of 8, demonstrating that the benefits of the ADT plus EBRT increase with worsening disease characteristics.
“The risk-stratification tool is simple and could easily be used in clinical practice, patient counseling, and in designing future clinical trials on the topic of management of prostate cancer with nodal metastasis,” Dr. Touijer said.
“Nodal metastasis at the time of radical prostatectomy does not necessarily equate to systemic disease,” he said. “Maximizing local control by way of high-quality surgery and radiation therapy can offer a survival benefit.”
SOURCE: http://bit.ly/2hlb4e2
Eur Urol 2017.
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