The survival impact of neoadjuvant hormonal therapy before radical prostatectomy for treatment of high-risk prostate cancer

L. Tosco; A. Laenen; A. Briganti; P. Gontero; R. J. Karnes; M. Albersen; P. J. Bastian; P. Chlosta; F. Claessens; F. K. Chun; W. Everaerts; C. Gratzke; M. Graefen; B. Kneitz; G. Marchioro; R. S. Salas; B. Tombal; T. Van Den Broeck; L. Moris; A. Battaglia; H. Van Der Poel; J. Walz; A. Bossi; G. De Meerleer; K. Haustermans; H. Van Poppel; M. Spahn; S. Joniau

doi:10.1038/pcan.2017.29

The survival impact of neoadjuvant hormonal therapy before radical prostatectomy for treatment of high-risk prostate cancer

L. Tosco, A. Laenen, A. Briganti, P. Gontero, R. J. Karnes, M. Albersen, P. J. Bastian, P. Chlosta, F. Claessens, F. K. Chun, W. Everaerts, C. Gratzke, M. Graefen, B. Kneitz, G. Marchioro, R. S. Salas, B. Tombal, T. Van Den Broeck, L. Moris, A. BattagliaH. Van Der Poel, J. Walz, A. Bossi, G. De Meerleer, K. Haustermans, H. Van Poppel, M. Spahn, S. Joniau

Urology

Research output: Contribution to journal › Article › peer-review

12 Scopus citations

Abstract

Background:Several randomized controlled trials assessed the outcomes of patients treated with neoadjuvant hormonal therapy (NHT) before radical prostatectomy (RP). The majority of them included mainly low and intermediate risk prostate cancer (PCa) without specifically assessing PCa-related death (PCRD). Thus, there is a lack of knowledge regarding a possible effect of NHT on PCRD in the high-risk PCa population. We aimed to analyze the effect of NHT on PCRD in a multicenter high-risk PCa population treated with RP, using a propensity-score adjustment.Methods:This is a retrospective multi-institutional study including patients with high-risk PCa defined as: clinical stage T3-4, PSA >20 ng ml â '1 or biopsy Gleason score 8-10. We compared PCRD between RP and NHT+RP using competing risks analysis. Correction for group differences was performed by propensity-score adjustment.Results:After application of the inclusion/exclusion criteria, 1573 patients remained for analysis; 1170 patients received RP and 403 NHT+RP. Median follow-up was 56 months (interquartile range 29-88). Eighty-six patients died of PCa and 106 of other causes. NHT decreased the risk of PCRD (hazard ratio (HR) 0.5; 95% confidence interval (CI) 0.32-0.80; P=0.0014). An interaction effect between NHT and radiotherapy (RT) was observed (HR 0.3; 95% CI 0.21-0.43; P<0.0008). More specifically, of patients who received adjuvant RT, those who underwent NHT+RP had decreased PCRD rates (2.3% at 5 year) compared to RP (7.5% at 5 year). The retrospective design and lack of specific information about NHT are possible limitations.Conclusions:In this propensity-score adjusted analysis from a large high-risk PCa population, NHT before surgery significantly decreased PCRD. This effect appeared to be mainly driven by the early addition of RT post-surgery. The specific sequence of NHT+RP and adjuvant RT merits further study in the high-risk PCa population.

Original language	English (US)
Pages (from-to)	407-412
Number of pages	6
Journal	Prostate Cancer and Prostatic Diseases
Volume	20
Issue number	4
DOIs	https://doi.org/10.1038/pcan.2017.29
State	Published - Dec 1 2017

ASJC Scopus subject areas

Oncology
Urology
Cancer Research

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10.1038/pcan.2017.29

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Tosco, L., Laenen, A., Briganti, A., Gontero, P., Karnes, R. J., Albersen, M., Bastian, P. J., Chlosta, P., Claessens, F., Chun, F. K., Everaerts, W., Gratzke, C., Graefen, M., Kneitz, B., Marchioro, G., Salas, R. S., Tombal, B., Van Den Broeck, T., Moris, L., ... Joniau, S. (2017). The survival impact of neoadjuvant hormonal therapy before radical prostatectomy for treatment of high-risk prostate cancer. Prostate Cancer and Prostatic Diseases, 20(4), 407-412. https://doi.org/10.1038/pcan.2017.29

Tosco, L, Laenen, A, Briganti, A, Gontero, P, Karnes, RJ, Albersen, M, Bastian, PJ, Chlosta, P, Claessens, F, Chun, FK, Everaerts, W, Gratzke, C, Graefen, M, Kneitz, B, Marchioro, G, Salas, RS, Tombal, B, Van Den Broeck, T, Moris, L, Battaglia, A, Van Der Poel, H, Walz, J, Bossi, A, De Meerleer, G, Haustermans, K, Van Poppel, H, Spahn, M & Joniau, S 2017, 'The survival impact of neoadjuvant hormonal therapy before radical prostatectomy for treatment of high-risk prostate cancer', Prostate Cancer and Prostatic Diseases, vol. 20, no. 4, pp. 407-412. https://doi.org/10.1038/pcan.2017.29

@article{d073c5791d274fa1b7fa42f8774003ab,

title = "The survival impact of neoadjuvant hormonal therapy before radical prostatectomy for treatment of high-risk prostate cancer",

abstract = "Background:Several randomized controlled trials assessed the outcomes of patients treated with neoadjuvant hormonal therapy (NHT) before radical prostatectomy (RP). The majority of them included mainly low and intermediate risk prostate cancer (PCa) without specifically assessing PCa-related death (PCRD). Thus, there is a lack of knowledge regarding a possible effect of NHT on PCRD in the high-risk PCa population. We aimed to analyze the effect of NHT on PCRD in a multicenter high-risk PCa population treated with RP, using a propensity-score adjustment.Methods:This is a retrospective multi-institutional study including patients with high-risk PCa defined as: clinical stage T3-4, PSA >20 ng ml {\^a} '1 or biopsy Gleason score 8-10. We compared PCRD between RP and NHT+RP using competing risks analysis. Correction for group differences was performed by propensity-score adjustment.Results:After application of the inclusion/exclusion criteria, 1573 patients remained for analysis; 1170 patients received RP and 403 NHT+RP. Median follow-up was 56 months (interquartile range 29-88). Eighty-six patients died of PCa and 106 of other causes. NHT decreased the risk of PCRD (hazard ratio (HR) 0.5; 95% confidence interval (CI) 0.32-0.80; P=0.0014). An interaction effect between NHT and radiotherapy (RT) was observed (HR 0.3; 95% CI 0.21-0.43; P<0.0008). More specifically, of patients who received adjuvant RT, those who underwent NHT+RP had decreased PCRD rates (2.3% at 5 year) compared to RP (7.5% at 5 year). The retrospective design and lack of specific information about NHT are possible limitations.Conclusions:In this propensity-score adjusted analysis from a large high-risk PCa population, NHT before surgery significantly decreased PCRD. This effect appeared to be mainly driven by the early addition of RT post-surgery. The specific sequence of NHT+RP and adjuvant RT merits further study in the high-risk PCa population.",

author = "L. Tosco and A. Laenen and A. Briganti and P. Gontero and Karnes, {R. J.} and M. Albersen and Bastian, {P. J.} and P. Chlosta and F. Claessens and Chun, {F. K.} and W. Everaerts and C. Gratzke and M. Graefen and B. Kneitz and G. Marchioro and Salas, {R. S.} and B. Tombal and {Van Den Broeck}, T. and L. Moris and A. Battaglia and {Van Der Poel}, H. and J. Walz and A. Bossi and {De Meerleer}, G. and K. Haustermans and {Van Poppel}, H. and M. Spahn and S. Joniau",

year = "2017",

month = dec,

day = "1",

doi = "10.1038/pcan.2017.29",

language = "English (US)",

volume = "20",

pages = "407--412",

journal = "Prostate Cancer and Prostatic Diseases",

issn = "1365-7852",

publisher = "Nature Publishing Group",

number = "4",

}

TY - JOUR

T1 - The survival impact of neoadjuvant hormonal therapy before radical prostatectomy for treatment of high-risk prostate cancer

AU - Tosco, L.

AU - Laenen, A.

AU - Briganti, A.

AU - Gontero, P.

AU - Karnes, R. J.

AU - Albersen, M.

AU - Bastian, P. J.

AU - Chlosta, P.

AU - Claessens, F.

AU - Chun, F. K.

AU - Everaerts, W.

AU - Gratzke, C.

AU - Graefen, M.

AU - Kneitz, B.

AU - Marchioro, G.

AU - Salas, R. S.

AU - Tombal, B.

AU - Van Den Broeck, T.

AU - Moris, L.

AU - Battaglia, A.

AU - Van Der Poel, H.

AU - Walz, J.

AU - Bossi, A.

AU - De Meerleer, G.

AU - Haustermans, K.

AU - Van Poppel, H.

AU - Spahn, M.

AU - Joniau, S.

PY - 2017/12/1

Y1 - 2017/12/1

N2 - Background:Several randomized controlled trials assessed the outcomes of patients treated with neoadjuvant hormonal therapy (NHT) before radical prostatectomy (RP). The majority of them included mainly low and intermediate risk prostate cancer (PCa) without specifically assessing PCa-related death (PCRD). Thus, there is a lack of knowledge regarding a possible effect of NHT on PCRD in the high-risk PCa population. We aimed to analyze the effect of NHT on PCRD in a multicenter high-risk PCa population treated with RP, using a propensity-score adjustment.Methods:This is a retrospective multi-institutional study including patients with high-risk PCa defined as: clinical stage T3-4, PSA >20 ng ml â '1 or biopsy Gleason score 8-10. We compared PCRD between RP and NHT+RP using competing risks analysis. Correction for group differences was performed by propensity-score adjustment.Results:After application of the inclusion/exclusion criteria, 1573 patients remained for analysis; 1170 patients received RP and 403 NHT+RP. Median follow-up was 56 months (interquartile range 29-88). Eighty-six patients died of PCa and 106 of other causes. NHT decreased the risk of PCRD (hazard ratio (HR) 0.5; 95% confidence interval (CI) 0.32-0.80; P=0.0014). An interaction effect between NHT and radiotherapy (RT) was observed (HR 0.3; 95% CI 0.21-0.43; P<0.0008). More specifically, of patients who received adjuvant RT, those who underwent NHT+RP had decreased PCRD rates (2.3% at 5 year) compared to RP (7.5% at 5 year). The retrospective design and lack of specific information about NHT are possible limitations.Conclusions:In this propensity-score adjusted analysis from a large high-risk PCa population, NHT before surgery significantly decreased PCRD. This effect appeared to be mainly driven by the early addition of RT post-surgery. The specific sequence of NHT+RP and adjuvant RT merits further study in the high-risk PCa population.

AB - Background:Several randomized controlled trials assessed the outcomes of patients treated with neoadjuvant hormonal therapy (NHT) before radical prostatectomy (RP). The majority of them included mainly low and intermediate risk prostate cancer (PCa) without specifically assessing PCa-related death (PCRD). Thus, there is a lack of knowledge regarding a possible effect of NHT on PCRD in the high-risk PCa population. We aimed to analyze the effect of NHT on PCRD in a multicenter high-risk PCa population treated with RP, using a propensity-score adjustment.Methods:This is a retrospective multi-institutional study including patients with high-risk PCa defined as: clinical stage T3-4, PSA >20 ng ml â '1 or biopsy Gleason score 8-10. We compared PCRD between RP and NHT+RP using competing risks analysis. Correction for group differences was performed by propensity-score adjustment.Results:After application of the inclusion/exclusion criteria, 1573 patients remained for analysis; 1170 patients received RP and 403 NHT+RP. Median follow-up was 56 months (interquartile range 29-88). Eighty-six patients died of PCa and 106 of other causes. NHT decreased the risk of PCRD (hazard ratio (HR) 0.5; 95% confidence interval (CI) 0.32-0.80; P=0.0014). An interaction effect between NHT and radiotherapy (RT) was observed (HR 0.3; 95% CI 0.21-0.43; P<0.0008). More specifically, of patients who received adjuvant RT, those who underwent NHT+RP had decreased PCRD rates (2.3% at 5 year) compared to RP (7.5% at 5 year). The retrospective design and lack of specific information about NHT are possible limitations.Conclusions:In this propensity-score adjusted analysis from a large high-risk PCa population, NHT before surgery significantly decreased PCRD. This effect appeared to be mainly driven by the early addition of RT post-surgery. The specific sequence of NHT+RP and adjuvant RT merits further study in the high-risk PCa population.

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U2 - 10.1038/pcan.2017.29

DO - 10.1038/pcan.2017.29

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VL - 20

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JO - Prostate Cancer and Prostatic Diseases

JF - Prostate Cancer and Prostatic Diseases

IS - 4

ER -

The survival impact of neoadjuvant hormonal therapy before radical prostatectomy for treatment of high-risk prostate cancer

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